Healthcare Provider Details

I. General information

NPI: 1598847196
Provider Name (Legal Business Name): DANIEL L ALTCHULER D P M PODIATRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 15TH ST STE 707
SANTA MONICA CA
90404-1145
US

IV. Provider business mailing address

1260 15TH ST SUITE 1020
SANTA MONICA CA
90404-1145
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-8045
  • Fax: 310-451-8139
Mailing address:
  • Phone: 310-451-8045
  • Fax: 310-451-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE01822
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EILEEN L HAWORTH
Title or Position: SECRETARY
Credential: D.C.
Phone: 310-451-8045