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General NPI Number Information
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NPI Number | 1497077580
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Entity Type | Individual
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Provider Name | TED ROBERT NEHRENBERG MD
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Gender | Male
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 3028 JAVA ROAD
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City | COSTA MESA
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State | CA
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Zip | 92626-3506
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Country | US
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Telephone | 714-546-3072
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Fax |
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Provider Business Mailing Address
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Address Line | 3028 JAVA ROAD
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City | COSTA MESA
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State | CA
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Zip | 92626-3506
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Country | US
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Telephone | 714-546-3072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | AFE17472
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License Number State | CA
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