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General NPI Number Information
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NPI Number | 1366240772
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Entity Type | Organization
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Legal Business Name | PRIME FOOT AND ANKLE INSTITUTE PC
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 26235 RAVENHILL RD
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City | SANTA CLARITA
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State | CA
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Zip | 91387-4046
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Country | US
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Telephone | 917-687-7528
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Fax | 818-241-3319
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Provider Business Mailing Address
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Address Line | 26235 RAVENHILL RD
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City | SANTA CLARITA
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State | CA
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Zip | 91387-4046
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Country | US
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Telephone | 917-687-7528
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Fax | 818-241-3319
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Authorized Official
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Title or Position | CEO
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Name | ALEKSANDER LAVRENOV
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Credential | DPM
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Telephone | 917-687-7528
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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 |
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License Number State |
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