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General NPI Number Information
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NPI Number | 1386185650
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Entity Type | Organization
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Legal Business Name | ARTISAN FOOT AND ANKLE PODIATRIC SPECIALISTS INC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 23141 MOULTON PKWY STE 109
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1241
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Country | US
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Telephone | 949-272-0007
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Fax | 949-272-0006
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Provider Business Mailing Address
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Address Line | PO BOX 31502
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City | BELFAST
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State | ME
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Zip | 04915-0168
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Country | US
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Telephone | 415-645-4525
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Fax | 510-399-1364
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEVON GLAZER
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Credential | DPM
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Telephone | 949-272-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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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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