Provider Demographics
NPI:1003222886
Name:DR. JOSEPH PLATINUM PODIATRY, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. JOSEPH PLATINUM PODIATRY, A PROFESSIONAL CORPORATION
Other - Org Name:PLATINUM PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:858-724-1511
Mailing Address - Street 1:18080 BEACH BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1342
Mailing Address - Country:US
Mailing Address - Phone:858-724-1511
Mailing Address - Fax:
Practice Address - Street 1:18080 BEACH BLVD
Practice Address - Street 2:STE 103
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1342
Practice Address - Country:US
Practice Address - Phone:858-724-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty