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General NPI Number Information
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NPI Number | 1124175740
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Entity Type | Organization
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Legal Business Name | FAR WEST PODIATRIC MEDICAL GROUP
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 13624 HAWTHORNE BLVD STE 206
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City | HAWTHORNE
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State | CA
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Zip | 90250-5818
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Country | US
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Telephone | 310-675-0900
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Fax | 310-675-0904
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Provider Business Mailing Address
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Address Line | 13624 HAWTHORNE BLVD SUITE 206
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City | HAWTHORNE
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State | CA
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Zip | 90250-5818
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Country | US
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Telephone | 310-675-0900
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Fax | 310-675-0904
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KAREN L WRUBEL
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Credential | DPM
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Telephone | 310-675-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | E3328
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License Number State | CA
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