Healthcare Provider Details

I. General information

NPI: 1043741358
Provider Name (Legal Business Name): GARVEY PODIATRY CLINIC, A PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/07/2023
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10138 GARVEY AVE SUITE #C
EL MONTE CA
91733-5012
US

IV. Provider business mailing address

10138 GARVEY AVE SUITE #C
EL MONTE CA
91733-5012
US

V. Phone/Fax

Practice location:
  • Phone: 626-361-7055
  • Fax: 626-768-7112
Mailing address:
  • Phone: 626-361-7055
  • Fax: 626-768-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRANG DUONG
Title or Position: CEO
Credential: DPM
Phone: 626-361-7055