Healthcare Provider Details

I. General information

NPI: 1710173489
Provider Name (Legal Business Name): GLENDALE FOOT & ANKLE PODIATRY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S ADAMS ST
GLENDALE CA
91205-1312
US

IV. Provider business mailing address

110 S ADAMS ST
GLENDALE CA
91205-1312
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-4426
  • Fax: 818-242-4409
Mailing address:
  • Phone: 818-242-4426
  • Fax: 818-242-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3761
License Number StateCA

VIII. Authorized Official

Name: DR. HERMOZ B AYVAZIAN
Title or Position: OWNER
Credential: DPM
Phone: 818-242-4426