Healthcare Provider Details

I. General information

NPI: 1124005137
Provider Name (Legal Business Name): STEFAN FELDMAN D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32144 AGOURA RD SUITE 105
WESTLAKE VILLAGE CA
91361-4031
US

IV. Provider business mailing address

2121 WILSHIRE BLVD STE 101
SANTA MONICA CA
90403-5742
US

V. Phone/Fax

Practice location:
  • Phone: 818-706-1925
  • Fax: 818-706-1369
Mailing address:
  • Phone: 310-828-0011
  • Fax: 310-828-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: