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NPI Code Detail

MEDICARE: ADVANCED FOOT AND ANKLE INSTITUTE, A PODIATRY CORPORATION

MEDICARE: ADVANCED FOOT AND ANKLE INSTITUTE, A PODIATRY CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery PodiatristE4547CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1W22394OTHERPTAN
2W22395OTHERPTAN #

General Provider Information

NPI Number : 1285856401
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED FOOT AND ANKLE INSTITUTE, A PODIATRY CORPORATION
Provider Business Mailing Address
First Line : PO BOX 280748
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91328-0748
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2840 E LOS ANGELES AVE
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-3937
Country : US
Telephone Number : 805-526-8360
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. PAYMAN HOSHYARSAR
Credential :
Telephone Number : 818-723-7862
Provider Enumeration Date : 05/03/2007
Last Update Date : 08/25/2008

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Directions to “ADVANCED FOOT AND ANKLE INSTITUTE, A PODIATRY CORPORATION ” Practice Location

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