Provider Demographics
NPI:1144349267
Name:FREDERIC H. CORBIN, M.D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:FREDERIC H. CORBIN, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:H
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-671-3033
Mailing Address - Street 1:400 W CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3013
Mailing Address - Country:US
Mailing Address - Phone:714-671-3033
Mailing Address - Fax:714-671-1231
Practice Address - Street 1:400 W CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3013
Practice Address - Country:US
Practice Address - Phone:714-671-3033
Practice Address - Fax:714-671-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK746AOtherMEDICARE PTAN