Healthcare Provider Details

I. General information

NPI: 1487916359
Provider Name (Legal Business Name): OENDRILA KAMAL D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 11/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25825 VERMONT AVE DEPARTMENT OF PODIATRY
HARBOR CITY CA
90710-3518
US

IV. Provider business mailing address

25825 VERMONT AVE DEPARTMENT OF PODIATRY
HARBOR CITY CA
90710-3518
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-2982
  • Fax:
Mailing address:
  • Phone: 310-517-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0116024710
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0116024710
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE-5188
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0116024710
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number0116024710
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number0116024710
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number0116024710
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0116024710
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: