Healthcare Provider Details

I. General information

NPI: 1033349220
Provider Name (Legal Business Name): PACIFIC FOOT AND ANKLE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W FOOTHILL BLVD UNIT F
SAN DIMAS CA
91773-1103
US

IV. Provider business mailing address

150 W FOOTHILL BLVD UNIT F
SAN DIMAS CA
91773-1103
US

V. Phone/Fax

Practice location:
  • Phone: 626-385-3388
  • Fax: 626-914-4119
Mailing address:
  • Phone: 626-385-3388
  • Fax: 626-914-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4526
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWIN OGHOORIAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 626-385-3338