MEDICARE: OLIVER FOSTER DPM A PROFESSIONAL CORP

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	E1092	CA

General Provider Information

NPI Number	:	1437303864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVER FOSTER DPM A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	4131 PUNTA ALTA DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1132
Country	:	US
Telephone Number	:	323-295-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	4131 PUNTA ALTA DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1132
Country	:	US
Telephone Number	:	323-295-9711
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OLIVER SIMMS FOSTER
Credential	:	DPM
Telephone Number	:	323-295-9711

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	04/30/2015

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