| NPI | 1760035216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW DANIEL CEO 661-917-1973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 213E00000X Podiatrist |
| 213EP1101X Podiatrist Primary Podiatric Medicine | |
| 213ER0200X Podiatrist Radiology | |
| 213ES0000X Podiatrist Sports Medicine | |
| 213ES0131X Podiatrist Foot Surgery | |
| 261QP1100X Clinic/Center Podiatric | |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2019-09-19 |