Provider Demographics
NPI: | 1861448268 |
---|---|
Name: | EINZIGER, JERALD P (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JERALD |
Middle Name: | P |
Last Name: | EINZIGER |
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: | PO BOX 16699 |
Mailing Address - Street 2: | |
Mailing Address - City: | IRVINE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92623-6699 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 949-263-8620 |
Mailing Address - Fax: | 949-263-1639 |
Practice Address - Street 1: | 18344 CLARK STREET |
Practice Address - Street 2: | SUITE 101 |
Practice Address - City: | TARZANA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91356 |
Practice Address - Country: | US |
Practice Address - Phone: | 818-881-9811 |
Practice Address - Fax: | 818-881-1638 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-26 |
Last Update Date: | 2007-11-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | C33950 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 00C339500 | Other | BLUE SHIELD |
CA | 00C339500 | Medicaid | |
CA | 00C339500 | Other | BLUE SHIELD |
A35435 | Medicare UPIN | ||
CA | WC33950J | Medicare PIN | |
CA | WC33950I | Medicare PIN | |
CA | P00238155 | Medicare PIN |