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General NPI Number Information
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NPI Number | 1538182878
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Entity Type | Individual
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Provider Name | ROGER FREDERIC DONENFELD M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 4650 LINCOLN BLVD
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6306
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Country | US
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Telephone | 310-821-5510
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Fax | 310-822-1826
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Provider Business Mailing Address
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Address Line | 10557 ROCCA PL
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City | LOS ANGELES
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State | CA
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Zip | 90077
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Country | US
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Telephone | 310-471-3777
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Fax | 323-209-0010
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G48336
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License Number State | CA
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