Individual
KEITH R FELDER SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
24658 CONSTELLATION WAY, MORENO VALLEY, CA 92551-7296
(951) 340-7072
Mailing address
24658 CONSTELLATION WAY, MORENO VALLEY, CA 92551-7296
(951) 340-7072
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
347C00000X
Private Vehicle
—
—
347E00000X
Transportation Broker
Primary
—
—
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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