Healthcare Provider Details

I. General information

NPI: 1942418348
Provider Name (Legal Business Name): FOOT SPECIALISTS OF NORTHRIDGE - PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 BALBOA BLVD STE 140
GRANADA HILLS CA
91344-6343
US

IV. Provider business mailing address

10515 BALBOA BLVD STE 140
GRANADA HILLS CA
91344-6343
US

V. Phone/Fax

Practice location:
  • Phone: 818-363-9900
  • Fax: 818-363-9915
Mailing address:
  • Phone: 818-363-9900
  • Fax: 818-363-9915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2279
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES A KELMAN
Title or Position: OWNER
Credential: D.P.M.
Phone: 818-363-9900