Healthcare Provider Details

I. General information

NPI: 1407669542
Provider Name (Legal Business Name): HOLLYWOOD FOOT AND ANKLE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11631 VICTORY BLVD STE 104
N HOLLYWOOD CA
91606-3572
US

IV. Provider business mailing address

11631 VICTORY BLVD STE 104
N HOLLYWOOD CA
91606-3572
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-6643
  • Fax:
Mailing address:
  • Phone: 909-946-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. FARID DIDARI
Title or Position: CFO
Credential: DPM
Phone: 909-464-8600