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General NPI Number Information
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NPI Number | 1255772414
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Entity Type | Organization
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Legal Business Name | ENCINO FOOT CARE A PROF CORP
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 17777 VENTURA BLVD SUITE 230
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City | ENCINO
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State | CA
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Zip | 91316-3736
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Country | US
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Telephone | 818-905-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 972
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City | WOODLAND HILLS
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State | CA
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Zip | 91365-0972
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Country | US
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Telephone | 818-905-1000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROSE DIANE GILMAN KLINE
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Credential | D.P.M.
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Telephone | 818-905-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E2775
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License Number State | CA
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