Healthcare Provider Details

I. General information

NPI: 1881643856
Provider Name (Legal Business Name): FOOTE-GOLDMAN-SAPKIN MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD SUITE 228
ENCINO CA
91316-5212
US

IV. Provider business mailing address

5400 BALBOA BLVD SUITE 228
ENCINO CA
91316-5212
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-2001
  • Fax: 818-788-2021
Mailing address:
  • Phone: 818-788-2001
  • Fax: 818-788-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN LEWIS SAPKIN
Title or Position: PRES/CEO
Credential: M.D.
Phone: 818-788-2001