Healthcare Provider Details

I. General information

NPI: 1750269007
Provider Name (Legal Business Name): UNIVERSAL PODIATRY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10908 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2210
US

IV. Provider business mailing address

10908 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2210
US

V. Phone/Fax

Practice location:
  • Phone: 818-698-3980
  • Fax:
Mailing address:
  • Phone: 818-698-3980
  • Fax: 818-698-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NINA C ROBINSON
Title or Position: CEO/OWNER
Credential: DPM
Phone: 818-698-3980