Provider Demographics
NPI:1730115221
Name:GORENBERG, ALAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:E
Last Name:GORENBERG
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 1:12380 HESPERIA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5814
Mailing Address - Country:US
Mailing Address - Phone:760-243-4188
Mailing Address - Fax:760-243-6888
Practice Address - Street 1:8506 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-2461
Practice Address - Country:US
Practice Address - Phone:714-633-4666
Practice Address - Fax:714-633-4640
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60876207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G608761OtherBLUE CROSS AND BLUE SHIELD
CA1770514945OtherNPI (INCORPERATED)
CA1730115221OtherNPI (INDIVIDUAL)
260035678OtherCOMMERCIAL
CAG60876OtherMEDICAL LICENSE
CA00G608762Medicare PIN
CA1770514945OtherNPI (INCORPERATED)
CAW20699Medicare PIN
CAWG60879AMedicare PIN
CAZZZ03747ZMedicare PIN
CADE4387Medicare PIN
260035678OtherCOMMERCIAL
00G608761OtherBLUE CROSS AND BLUE SHIELD