| NPI | 1962566703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN LEONARD BERGHOUT Owner 949-433-5262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4205) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2020-08-22 |