Healthcare Provider Details

I. General information

NPI: 1942483862
Provider Name (Legal Business Name): UNIVERSITY FOOT AND ANKLE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 MILLIKEN AVE BLDG. B SUITE 330
RANCHO CUCAMONGA CA
91730-6780
US

IV. Provider business mailing address

2121 WILSHIRE BLVD SUITE 101
SANTA MONICA CA
90403-5720
US

V. Phone/Fax

Practice location:
  • Phone: 909-204-9700
  • Fax: 310-828-2001
Mailing address:
  • Phone: 310-828-0011
  • Fax: 310-828-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4729
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4186
License Number StateCA

VIII. Authorized Official

Name: DR. BABAK BARAVARIAN
Title or Position: OWNER
Credential: DPM
Phone: 310-828-0011