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General NPI Number Information
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NPI Number | 1992044358
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Entity Type | Organization
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Legal Business Name | UNIVERSITY FOOT AND ANKLE INSTITUTE A PODIATRIC SURGICAL CENTER
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 295 IMPERIAL HWY
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City | FULLERTON
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State | CA
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Zip | 92835-1020
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Country | US
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Telephone | 310-828-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 WILSHIRE BLVD SUITE 101
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City | SANTA MONICA
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State | CA
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Zip | 90403-5720
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Country | US
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Telephone | 310-828-0011
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BABAK BARAVARIAN
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Credential | DPM
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Telephone | 310-282-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E4186
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E3141
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E4928
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License Number State | CA
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