Healthcare Provider Details

I. General information

NPI: 1558551333
Provider Name (Legal Business Name): RODNEY E SANNEMAN, D.P.M. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E ORANGE GROVE AVE STE A
BURBANK CA
91502-1240
US

IV. Provider business mailing address

255 E ORANGE GROVE AVE STE A
BURBANK CA
91502-1240
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-3600
  • Fax: 818-843-0527
Mailing address:
  • Phone: 818-843-3600
  • Fax: 818-843-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE-1337
License Number StateCA

VIII. Authorized Official

Name: DR. RODNEY ERNEST SANNEMAN
Title or Position: OWNER
Credential: D.P.M.
Phone: 818-843-3600