Provider Demographics
NPI:1003077306
Name:DAWN R. BURATTI, D.P.M., INC
Entity Type:Organization
Organization Name:DAWN R. BURATTI, D.P.M., INC
Other - Org Name:BURATTI FOOT AND ANKLE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BURATTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-701-6300
Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1502
Mailing Address - Country:US
Mailing Address - Phone:818-907-6100
Mailing Address - Fax:866-513-4995
Practice Address - Street 1:5400 BALBOA BLVD STE 325
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5226
Practice Address - Country:US
Practice Address - Phone:818-701-6300
Practice Address - Fax:866-513-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4170213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty