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General NPI Number Information
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NPI Number | 1780928762
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Entity Type | Organization
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Legal Business Name | BEACH CITIES PODIATRY GROUP, INC.
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 7098 EDINGER AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-3503
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Country | US
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Telephone | 714-848-3663
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Fax | 714-848-0565
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Provider Business Mailing Address
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Address Line | 7098 EDINGER AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-3503
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Country | US
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Telephone | 714-848-3663
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Fax | 714-848-0565
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANCY T HAYATA
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Credential | DPM
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Telephone | 714-848-3663
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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 |
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License Number State |
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