Healthcare Provider Details

I. General information

NPI: 1285337972
Provider Name (Legal Business Name): PLS FOOT DOCTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18740 VENTURA BLVD STE 102
TARZANA CA
91356-6353
US

IV. Provider business mailing address

18740 VENTURA BLVD STE 102
TARZANA CA
91356-6353
US

V. Phone/Fax

Practice location:
  • Phone: 661-618-8081
  • Fax:
Mailing address:
  • Phone: 661-618-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK R SHELLY
Title or Position: OWNER
Credential: MD
Phone: 661-618-8081