Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G60876 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | G60876 | CA |
NPI | 1730115221 |
---|---|
Provider Name | Dr. Alan E. Gorenberg |
First Address | Victorville, CA 92395-5814 |
Second Address | Orange, CA 92869-2461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 14/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G608761 | BLUE CROSS AND BLUE SHIELD (01) | |
1730115221 | NPI (INDIVIDUAL) (01) | CA |
1770514945 | NPI (INCORPERATED) (01) | CA |
260035678 | COMMERCIAL (01) | |
E93428 | (02) | CA |
G60876 | MEDICAL LICENSE (01) | CA |