Provider Demographics
NPI:1609964121
Name:ALBANO, FELIX (MD)
Entity Type:Individual
Prefix:MR
First Name:FELIX
Middle Name:
Last Name:ALBANO
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 1:685 CARNEGIE DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3583
Mailing Address - Country:US
Mailing Address - Phone:909-890-0407
Mailing Address - Fax:909-890-0575
Practice Address - Street 1:16455 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3554
Practice Address - Country:US
Practice Address - Phone:760-947-2161
Practice Address - Fax:760-947-3673
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A541260Medicaid
CA00A353000OtherMEDI-CAL
C44810Medicare UPIN
CA00A353000OtherMEDI-CAL
CABU998ZMedicare PIN