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General NPI Number Information
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NPI Number | 1154518801
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Entity Type | Organization
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Legal Business Name | ERIC J. KLOSTERMANN, D.P.M., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 4560 ADMIRALTY WAY SUITE 351
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5423
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC J KLOSTERMANN
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Credential | D.P.M.
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Telephone | 310-792-3914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | E1993
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License Number State | CA
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