Provider Demographics
NPI:1366557910
Name:GARY M. FEINBERG, MD, FACS, INC.
Entity type:Organization
Organization Name:GARY M. FEINBERG, MD, FACS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-788-1447
Mailing Address - Street 1:6950 BROCKTON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3831
Mailing Address - Country:US
Mailing Address - Phone:951-788-1447
Mailing Address - Fax:951-788-1485
Practice Address - Street 1:6950 BROCKTON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3831
Practice Address - Country:US
Practice Address - Phone:951-788-1447
Practice Address - Fax:951-788-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58691174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1730187881OtherINDIVIDUAL NPI
AR1730187881OtherINDIVIDUAL NPI