Healthcare Provider Details

I. General information

NPI: 1487723219
Provider Name (Legal Business Name): FOOT AND ANKLE INSTITUTE OF THE WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29525 CANWOOD ST STE 309
AGOURA HILLS CA
91301-4232
US

IV. Provider business mailing address

12660 RIVERSIDE DR STE 305
STUDIO CITY CA
91607-3431
US

V. Phone/Fax

Practice location:
  • Phone: 818-623-5333
  • Fax: 818-735-0110
Mailing address:
  • Phone: 818-623-4455
  • Fax: 818-985-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2173
License Number StateCA

VIII. Authorized Official

Name: DR. QUINN MARTIN FAURIA
Title or Position: OWNER
Credential: DPM
Phone: 818-623-4455