Healthcare Provider Details

I. General information

NPI: 1912377680
Provider Name (Legal Business Name): WALTER S KANTOR DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23412 MOULTON PKWY SUITE 100
LAGUNA HILLS CA
92653-1732
US

IV. Provider business mailing address

23412 MOULTON PKWY SUITE 100
LAGUNA HILLS CA
92653-1732
US

V. Phone/Fax

Practice location:
  • Phone: 949-300-0615
  • Fax:
Mailing address:
  • Phone: 949-300-0615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE3318
License Number StateCA

VIII. Authorized Official

Name: DR. WALTER STANLEY KANTOR
Title or Position: DOCTOR
Credential: DPM
Phone: 949-300-0615