Provider Demographics
NPI:1538267042
Name:BIRNBAUM, PETER SIMON (DO INC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:SIMON
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:DO INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W LA PALMA AVE
Mailing Address - Street 2:STE 506
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2812
Mailing Address - Country:US
Mailing Address - Phone:714-491-3670
Mailing Address - Fax:714-533-6760
Practice Address - Street 1:1211 W LA PALMA AVE STE 506
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2812
Practice Address - Country:US
Practice Address - Phone:714-491-3670
Practice Address - Fax:714-533-6760
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7133207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX71330Medicaid
CA20A7133Medicare ID - Type Unspecified
CA125955Medicare UPIN