Provider Demographics
NPI:1972785889
Name:WADE FAERBER D.O., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:WADE FAERBER D.O., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAERBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-296-6676
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-1007
Mailing Address - Country:US
Mailing Address - Phone:951-696-9061
Mailing Address - Fax:951-696-9262
Practice Address - Street 1:40949 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6031
Practice Address - Country:US
Practice Address - Phone:951-696-9061
Practice Address - Fax:951-696-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6291207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF10030Medicare UPIN