Healthcare Provider Details

I. General information

NPI: 1689744666
Provider Name (Legal Business Name): WEST COAST FOOT AND ANKLE PODIATRIC MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE 309
LONG BEACH CA
90804-2105
US

IV. Provider business mailing address

1760 TERMINO AVE 309
LONG BEACH CA
90804-2105
US

V. Phone/Fax

Practice location:
  • Phone: 562-986-6886
  • Fax:
Mailing address:
  • Phone: 562-986-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4395
License Number StateCA

VIII. Authorized Official

Name: DR. TROY R LEAMING
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 562-986-6886