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General NPI Number Information
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NPI Number | 1710231626
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Entity Type | Organization
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Legal Business Name | PACIFIC DIABETES INSTITUTE, INC.
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 15107 VANOWEN ST AMPUTATION PREVENTION CENTER - 4 EAST
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City | VAN NUYS
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State | CA
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Zip | 91405-4542
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Country | US
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Telephone | 818-902-5755
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Fax | 818-904-3708
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Provider Business Mailing Address
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Address Line | PO BOX 914
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City | BEVERLY HILLS
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State | CA
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Zip | 90213-0914
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Country | US
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Telephone | 310-869-8857
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. DAVID POUGATSCH
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Credential | D.P.M.
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Telephone | 310-869-8857
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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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