Healthcare Provider Details

I. General information

NPI: 1073660353
Provider Name (Legal Business Name): GLENOAKS PODIATRY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WEST GLENOAKS BLVD
GLENDALE CA
91202-2134
US

IV. Provider business mailing address

844 WEST GLENOAKS BLVD
GLENDALE CA
91202-2134
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-1888
  • Fax: 818-500-0695
Mailing address:
  • Phone: 818-500-1888
  • Fax: 818-500-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2857
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2979
License Number StateCA

VIII. Authorized Official

Name: DR. GULBENK SHIRVANIAN JR.
Title or Position: PRESIDENT
Credential: DPM
Phone: 818-500-1888