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General NPI Number Information
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NPI Number | 1710173489
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Entity Type | Organization
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Legal Business Name | GLENDALE FOOT & ANKLE PODIATRY CENTER, INC.
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Dates
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Enumeration Date | 09/17/2007
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 110 S ADAMS ST
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City | GLENDALE
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State | CA
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Zip | 91205-1312
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Country | US
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Telephone | 818-242-4426
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Fax | 818-242-4409
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Provider Business Mailing Address
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Address Line | 110 S ADAMS ST
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City | GLENDALE
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State | CA
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Zip | 91205-1312
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Country | US
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Telephone | 818-242-4426
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Fax | 818-242-4409
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Authorized Official
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Title or Position | OWNER
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Name | DR. HERMOZ B AYVAZIAN
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Credential | DPM
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Telephone | 818-242-4426
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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 | E3761
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License Number State | CA
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