Healthcare Provider Details

I. General information

NPI: 1669658043
Provider Name (Legal Business Name): COMPLETE CARE PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13132 STUDEBAKER RD SUITE 2
NORWALK CA
90650-2557
US

IV. Provider business mailing address

311 N ROBERTSON BLVD #677
BEVERLY HILLS CA
90211-1705
US

V. Phone/Fax

Practice location:
  • Phone: 562-651-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4302
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES T BEATY
Title or Position: PARTNER
Credential: DPM
Phone: 805-646-7163