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General NPI Number Information
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NPI Number | 1396128625
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Entity Type | Organization
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Legal Business Name | IMPERIAL FOOT AND ANKLE SPECIALISTS, INC
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 35400 BOB HOPE DR SUITE 212
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-1772
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Country | US
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Telephone | 760-327-1254
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Fax | 760-864-1499
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Provider Business Mailing Address
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Address Line | 35400 BOB HOPE DR STE 211
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-1774
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Country | US
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Telephone | 760-327-1254
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Fax | 760-864-1499
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY A KING
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Credential | D.P.M.
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Telephone | 760-327-1254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | E3942
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License Number State | CA
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