Healthcare Provider Details

I. General information

NPI: 1912373952
Provider Name (Legal Business Name): DAVID A. POUGATSCH, DPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROBERTSON BLVD STE 106
BEVERLY HILLS CA
90211-1767
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD # 682
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 310-919-4179
  • Fax: 877-239-0994
Mailing address:
  • Phone: 818-922-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4977
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID POUGATSCH
Title or Position: CEO
Credential:
Phone: 818-922-2244