Healthcare Provider Details

I. General information

NPI: 1780746685
Provider Name (Legal Business Name): EARL L CHERNIAK DPM A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3984 SO FIGUEROA ST
LOS ANGELES CA
90037
US

IV. Provider business mailing address

11724 GWYNNE LANE
LOS ANGELES CA
90077
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-7272
  • Fax: 310-476-8003
Mailing address:
  • Phone: 310-476-5397
  • Fax: 310-476-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1180
License Number StateCA

VIII. Authorized Official

Name: EARL LOWELL CHERNIAK
Title or Position: PRESIDENT
Credential: DPM
Phone: 310-476-5397