Provider Demographics
NPI:1568404572
Name:FEINGOLD, MITCHELL L (DPM)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:L
Last Name:FEINGOLD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 LA JOLLA BLVD
Mailing Address - Street 2:#419
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7651
Mailing Address - Country:US
Mailing Address - Phone:858-550-8110
Mailing Address - Fax:858-550-8087
Practice Address - Street 1:2306 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1643
Practice Address - Country:US
Practice Address - Phone:858-550-8110
Practice Address - Fax:858-550-8087
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-1436213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E14360Medicaid
CAE1436Medicare ID - Type Unspecified
CA000E14360Medicaid