Basic Information
| Provider Information | |||||||||
| NPI: | 1427162783 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FEINSTEIN & ROE MDS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 514 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134825141 | ||||||||
| FaxNumber: | 2134828128 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 514 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134825141 | ||||||||
| FaxNumber: | 2134828128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 06/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | AIDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLER | ||||||||
| AuthorizedOfficialTelephone: | 2134825141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A48134 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | GR0041130 | 05 | CA | MEDICAID |