Healthcare Provider Details

I. General information

NPI: 1760436596
Provider Name (Legal Business Name): AGIM GASHI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3149 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-7209
US

IV. Provider business mailing address

9100 SO SEPULVEDA BLVD SUITE 100
LOS ANGELES CA
90045-4849
US

V. Phone/Fax

Practice location:
  • Phone: 337-706-3415
  • Fax:
Mailing address:
  • Phone: 310-645-3338
  • Fax: 310-645-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: