Healthcare Provider Details

I. General information

NPI: 1164372595
Provider Name (Legal Business Name): FOUNDATION MEDICAL INSTITUTE, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 ETIWANDA AVE STE 228
TARZANA CA
91356-6157
US

IV. Provider business mailing address

10573 W PICO BLVD # 822
LOS ANGELES CA
90064-2333
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-5015
  • Fax:
Mailing address:
  • Phone: 310-571-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RITU JAIN VISWANATH
Title or Position: MANAGING MEMBER/CHIEF MEDICAL OFFI
Credential: MD
Phone: 310-571-5015