Healthcare Provider Details

I. General information

NPI: 1790607992
Provider Name (Legal Business Name): ADVANCED FOOT AND ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26235 RAVENHILL RD
SANTA CLARITA CA
91387-4046
US

IV. Provider business mailing address

26235 RAVENHILL RD
SANTA CLARITA CA
91387-4046
US

V. Phone/Fax

Practice location:
  • Phone: 917-687-7528
  • Fax: 818-344-4446
Mailing address:
  • Phone: 917-687-7528
  • Fax: 818-344-4446

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: ALEKSANDER LAVRENOV
Title or Position: CEO
Credential: DPM
Phone: 917-687-7528