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General NPI Number Information
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NPI Number | 1083760995
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Entity Type | Individual
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Provider Name | RUSSELL J WOJCIK D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 419 1/2 N LARCHMONT BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-3013
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Country | US
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Telephone | 213-385-1266
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Fax |
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Provider Business Mailing Address
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Address Line | 12807 ELKWOOD ST
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91605-2035
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Country | US
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Telephone | 213-385-1266
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E1920
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License Number State | CA
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