Provider Demographics
NPI:1396935243
Name:PAUL H. NIEBERG, M.D. INC.
Entity type:Organization
Organization Name:PAUL H. NIEBERG, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:NIEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-584-1341
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-1449
Mailing Address - Country:US
Mailing Address - Phone:714-996-1633
Mailing Address - Fax:714-996-9267
Practice Address - Street 1:960 E GREEN ST STE 105
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2443
Practice Address - Country:US
Practice Address - Phone:626-304-0782
Practice Address - Fax:626-658-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67350207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A673500OtherBLUE SHIELD OF CALIFORNIA
CADB9540OtherRAILROAD MEDICARE GROUP I
CA1902909187OtherINDIVIDUAL MEDICARE NPI N
CA00A673500OtherMEDI-CAL
CAP00139012OtherRAILROAD MEDICARE PROVIDE
CAW17391AMedicare PIN