Healthcare Provider Details

I. General information

NPI: 1790583086
Provider Name (Legal Business Name): LA PODIATRY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12840 RIVERSIDE DR STE 204
NORTH HOLLYWOOD CA
91607-3341
US

IV. Provider business mailing address

12840 RIVERSIDE DR STE 204
NORTH HOLLYWOOD CA
91607-3341
US

V. Phone/Fax

Practice location:
  • Phone: 818-850-3612
  • Fax: 818-301-0336
Mailing address:
  • Phone: 818-850-3612
  • Fax: 818-301-0336

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: ARASH JALIL
Title or Position: PODIATRIST
Credential:
Phone: 818-850-3612