Provider Demographics
NPI:1730270331
Name:FEFFER, MYRA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:LEE
Last Name:FEFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 BASIL LN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-2006
Mailing Address - Country:US
Mailing Address - Phone:310-470-8878
Mailing Address - Fax:310-470-8878
Practice Address - Street 1:16111 PLUMMER ST
Practice Address - Street 2:
Practice Address - City:SEPULVEDA
Practice Address - State:CA
Practice Address - Zip Code:91343-2036
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGI2306171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38613Medicare UPIN