Individual
MR. PAUL HENRY NIEBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
960 E GREEN ST STE 105, PASADENA, CA 91106-2443
(626) 304-0782
(626) 310-0552
Mailing address
PO BOX 1449, BREA, CA 92822-1449
(714) 996-1633
(714) 996-9267
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
A67350
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A673500
BLUE SHIELD
CA
05
—
00A673500
—
CA
01
—
DB9540
RAILROAD RETIREMENT
GA
01
—
P00139012
RAILROAD MEDICARE PROVIDE
CA
Enumeration date
09/06/2006
Last updated
10/27/2023
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