Healthcare Provider Details

I. General information

NPI: 1598372666
Provider Name (Legal Business Name): MRR FOOT & ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E OLIVE AVE STE 840
BURBANK CA
91501-2180
US

IV. Provider business mailing address

6444 SAN FERNANDO RD UNIT 5611
GLENDALE CA
91201-5079
US

V. Phone/Fax

Practice location:
  • Phone: 213-373-3246
  • Fax: 800-878-5903
Mailing address:
  • Phone: 213-373-3246
  • Fax: 800-878-5903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTINA RANDALL
Title or Position: PRESIDENT
Credential: DPM
Phone: 267-934-6996