Healthcare Provider Details

I. General information

NPI: 1801868013
Provider Name (Legal Business Name): FOOT SPECIALISTS OF NORTHRIDGE - PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32144 AGOURA RD. SUITE 105
WESTLAKE VILLAGE CA
91361
US

IV. Provider business mailing address

10515 BALBOA BLVD. SUITE 140
GRANADA HILLS CA
91344
US

V. Phone/Fax

Practice location:
  • Phone: 818-706-1924
  • Fax: 818-706-1369
Mailing address:
  • Phone: 818-363-9900
  • Fax: 818-363-9915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE-2430
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE-2279
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. STEFAN FELDMAN
Title or Position: OWNER
Credential: D.P.M.
Phone: 818-706-1924