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General NPI Number Information
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NPI Number | 1730623620
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE CHAMPIONS INCD
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 2288 WESTWOOD BLVD 100
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City | LOS ANGELES
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State | CA
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Zip | 90064
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Country | US
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Telephone | 310-475-5377
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Fax | 310-446-1825
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Provider Business Mailing Address
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Address Line | 4115 CENTRALIA ST
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City | LAKEWOOD
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State | CA
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Zip | 90712
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Country | US
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Telephone | 562-857-7823
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Fax | 310-446-1825
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. MICHAEL CORPUZ
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Credential | DPM
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Telephone | 310-475-5377
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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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