Provider Demographics
NPI:1912035080
Name:FELBER, CORNELIA CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:CHRISTINE
Last Name:FELBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4644 LINCOLN BLVD
Mailing Address - Street 2:SUITE 552
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6313
Mailing Address - Country:US
Mailing Address - Phone:310-827-2653
Mailing Address - Fax:310-823-1984
Practice Address - Street 1:4644 LINCOLN BLVD
Practice Address - Street 2:SUITE 552
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6313
Practice Address - Country:US
Practice Address - Phone:310-827-2653
Practice Address - Fax:310-823-1984
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954766478OtherEIN