Healthcare Provider Details

I. General information

NPI: 1578585550
Provider Name (Legal Business Name): ALLEN MASSIHI, PODIATRIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N VERDUGO RD
GLENDALE CA
91206-3944
US

IV. Provider business mailing address

4058 WOODCLIFF RD
SHERMAN OAKS CA
91403-4334
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-9912
  • Fax: 818-553-1720
Mailing address:
  • Phone: 818-748-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4353
License Number StateCA

VIII. Authorized Official

Name: ALLEN MASSIHI
Title or Position: DOCTOR PODIATRIC MEDICINE
Credential: DPM
Phone: 818-748-7319