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General NPI Number Information
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NPI Number | 1235318122
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Entity Type | Organization
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Legal Business Name | SONNY PODIATRY GROUP, INC.
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 3756 SANTA ROSALIA DR STE 505
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City | LOS ANGELES
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State | CA
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Zip | 90008-3656
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Country | US
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Telephone | 323-291-3963
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Fax |
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Provider Business Mailing Address
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Address Line | 3756 SANTA ROSALIA DR STE 505
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City | LOS ANGELES
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State | CA
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Zip | 90008-3656
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Country | US
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Telephone | 323-291-3963
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Fax |
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Authorized Official
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Title or Position | PODRITRIST
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Name | MR. ROBERT L. WILLIAMS
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Credential | D.P.M.
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Telephone | 323-291-3963
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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 | E3405
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License Number State | CA
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