Healthcare Provider Details

I. General information

NPI: 1538109863
Provider Name (Legal Business Name): PLS PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 W BURBANK BLVD
BURBANK CA
91505-2117
US

IV. Provider business mailing address

3906 W BURBANK BLVD
BURBANK CA
91505-2117
US

V. Phone/Fax

Practice location:
  • Phone: 818-238-9892
  • Fax:
Mailing address:
  • Phone: 818-238-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4653
License Number StateCA

VIII. Authorized Official

Name: DR. MOHAMMED AHMEDUDDIN
Title or Position: DOCTOR
Credential: DPM
Phone: 714-334-6214