Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A055426 | CA |
NPI | 1033323118 |
---|---|
Provider Name | Brian Jeffrey Eichenberg |
First Address | Murrieta, CA 92562-9591 |
Second Address | Murrieta, CA 92562-9591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 12/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A554260 | (05) | CA |
H18378 | (02) | CA |