Healthcare Provider Details

I. General information

NPI: 1982140224
Provider Name (Legal Business Name): LPR PODIATRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
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

311 N VERDUGO RD
GLENDALE CA
91206-3944
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALLEN MASSIHI
Title or Position: PRESIDENT
Credential: DPM
Phone: 818-409-9912