Provider Demographics
NPI:1033323118
Name:EICHENBERG, BRIAN JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JEFFREY
Last Name:EICHENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24687 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9591
Mailing Address - Country:US
Mailing Address - Phone:951-506-1040
Mailing Address - Fax:951-506-1044
Practice Address - Street 1:24687 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9591
Practice Address - Country:US
Practice Address - Phone:951-506-1040
Practice Address - Fax:951-506-1044
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0554262086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554260Medicaid
CA00A554260Medicare PIN
CAH18378Medicare UPIN