Healthcare Provider Details

I. General information

NPI: 1184899213
Provider Name (Legal Business Name): MAURICE R MASLIAH DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD STE 225
ENCINO CA
91316-5215
US

IV. Provider business mailing address

5400 BALBOA BLVD #225
ENCINO CA
91316
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-3344
  • Fax: 818-981-4777
Mailing address:
  • Phone: 818-981-3344
  • Fax: 818-981-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1951
License Number StateCA

VIII. Authorized Official

Name: MS. DEBORAH LANHAM
Title or Position: OFFICE MGR
Credential:
Phone: 818-981-3344