Provider Demographics
NPI:1508634700
Name:FELDER, KEITH R SR
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:FELDER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24658 CONSTELLATION WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-7296
Mailing Address - Country:US
Mailing Address - Phone:951-340-7072
Mailing Address - Fax:
Practice Address - Street 1:24658 CONSTELLATION WAY
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-7296
Practice Address - Country:US
Practice Address - Phone:951-340-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle