MEDICARE: PLS PODIATRY GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E41591	CA

General Provider Information

NPI Number	:	1245216738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLS PODIATRY GROUP

Provider Business Mailing Address
First Line	:	2661 E FLORENCE AVE STE B
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4793
Country	:	US
Telephone Number	:	323-583-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2661 E FLORENCE AVE
Second Line	:	STE B
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255
Country	:	US
Telephone Number	:	323-583-4440
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER AYODELE OTIKO
Credential	:	MD
Telephone Number	:	818-836-2475

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	06/14/2022

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