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General NPI Number Information
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NPI Number | 1912085069
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE INSTITUTE OF THE WEST
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 25272 MCINTYRE ST STE H
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5449
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Country | US
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Telephone | 186-234-4558
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Fax | 818-691-7099
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Provider Business Mailing Address
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Address Line | 18433 ROSCOE BLVD STE 214
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4123
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Country | US
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Telephone | 818-623-4455
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Fax | 818-691-7099
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Authorized Official
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Title or Position | OWNER
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Name | DR. QUINN MARTIN FAURIA
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Credential | DPM
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Telephone | 818-623-4455
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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 | BUS0301512
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License Number State | CA
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