Healthcare Provider Details

I. General information

NPI: 1710873187
Provider Name (Legal Business Name): NATIONAL FOOT AND ANKLE CENTER PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14981 NATIONAL AVE STE 2
LOS GATOS CA
95032-2600
US

IV. Provider business mailing address

14981 NATIONAL AVE STE 2
LOS GATOS CA
95032-2600
US

V. Phone/Fax

Practice location:
  • Phone: 408-884-5851
  • Fax: 669-327-2659
Mailing address:
  • Phone: 408-884-5851
  • Fax: 669-327-2659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: FARANAK POURGHASEMI
Title or Position: PRESIDENT
Credential: DPM
Phone: 408-884-5851