Healthcare Provider Details

I. General information

NPI: 1689716763
Provider Name (Legal Business Name): TODD A POWERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E VALLEY BLVD
EL MONTE CA
91732-3040
US

IV. Provider business mailing address

5040 MONTEZUMA ST
LOS ANGELES CA
90042-3229
US

V. Phone/Fax

Practice location:
  • Phone: 626-401-2775
  • Fax: 626-401-9826
Mailing address:
  • Phone: 310-497-3580
  • Fax: 310-497-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: