Provider Demographics
NPI:1497077580
Name:NEHRENBERG, TED ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:ROBERT
Last Name:NEHRENBERG
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 1:3028 JAVA ROAD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3506
Mailing Address - Country:US
Mailing Address - Phone:714-546-3072
Mailing Address - Fax:
Practice Address - Street 1:3028 JAVA ROAD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3506
Practice Address - Country:US
Practice Address - Phone:714-546-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE17472207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology