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General NPI Number Information
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NPI Number | 1932386877
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Entity Type | Organization
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Legal Business Name | AGOURA-LOS ROBLES PODIATRY CENTERS
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 05/23/2020
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Provider Practice Location Address
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Address Line | 555 MARIN ST SUITE 290
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4236
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Country | US
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Telephone | 818-707-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 555 MARIN ST SUITE 290
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4236
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Country | US
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Telephone | 818-707-3668
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DARREN PAYNE
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Credential | DPM
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Telephone | 818-707-3668
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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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