Healthcare Provider Details

I. General information

NPI: 1568576528
Provider Name (Legal Business Name): CONVALESCENT PODIATRY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 DEL AMO BLVD STE 102
LAKEWOOD CA
90712-2761
US

IV. Provider business mailing address

5445 DEL AMO BLVD STE 102
LAKEWOOD CA
90712-2761
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-0811
  • Fax: 562-866-4046
Mailing address:
  • Phone: 562-867-0811
  • Fax: 562-866-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN BENIK
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 562-867-0811