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General NPI Number Information
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NPI Number | 1295813491
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE INSTITUTE OF THE WEST A PODIATRY CORPORATION
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 18433 ROSCOE BLVD STE 214
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4123
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Country | US
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Telephone | 818-985-0055
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Fax |
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Provider Business Mailing Address
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Address Line | 12660 RIVERSIDE DR STE 305
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City | STUDIO CITY
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State | CA
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Zip | 91607-3431
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Country | US
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Telephone | 818-623-4455
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Fax | 818-985-0055
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Authorized Official
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Title or Position | OWNER
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Name | DR. QUINN MARTIN FAURIA
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Credential | DPM
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Telephone | 818-623-4455
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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 | 88417627
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License Number State | CA
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