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General NPI Number Information
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NPI Number | 1689066581
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Entity Type | Organization
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Legal Business Name | VALLEY FOOT CLINIC PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 14600 SHERMAN WAY STE 230
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City | VAN NUYS
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State | CA
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Zip | 91405-2291
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Country | US
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Telephone | 818-784-8420
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Fax | 818-785-0028
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Provider Business Mailing Address
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Address Line | 14600 SHERMAN WAY STE 230
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City | VAN NUYS
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State | CA
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Zip | 91405-2291
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Country | US
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Telephone | 818-519-2294
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Fax |
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Authorized Official
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Title or Position | MEDICAL ASSISTANT
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Name | MS. CINTHIA HERNANDEZ
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Credential | M.A.
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Telephone | 818-784-8420
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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 | E4452
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License Number State | CA
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