| |
10515 Balboa Blvd Ste 140, Granada Hills, CA 91344-6350 | |
(310) 828-0011 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist |
Location | 10515 Balboa Blvd Ste 140, Granada Hills, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1104323963 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
2121 Wilshire Blvd Ste 101, Santa Monica, CA 90403-5742 Ph: (310) 828-0011 | 10515 Balboa Blvd Ste 140, Granada Hills, CA 91344-6350 Ph: (310) 828-0011 |