Healthcare Provider Details

I. General information

NPI: 1457735383
Provider Name (Legal Business Name): UNIVERSITY FOOT AND ANKLE INSTITUTE A PODIATRIC SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 COCHRAN ST STE 5
SIMI VALLEY CA
93065-2789
US

IV. Provider business mailing address

2121 WILSHIRE BLVD 101
SANTA MONICA CA
90403-5720
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-0011
  • 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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3141
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4186
License Number StateCA

VIII. Authorized Official

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