Provider Demographics
NPI:1023020344
Name:UNIVERSITY PODIATRY GROUP, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PODIATRY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-443-8999
Mailing Address - Street 1:100 UCLA MEDICAL PLZ
Mailing Address - Street 2:#460
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-6909
Mailing Address - Country:US
Mailing Address - Phone:310-443-8999
Mailing Address - Fax:310-208-4847
Practice Address - Street 1:100 UCLA MEDICAL PLZ
Practice Address - Street 2:#460
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-6909
Practice Address - Country:US
Practice Address - Phone:310-443-8999
Practice Address - Fax:310-208-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24773ZOtherBLUE SHIELD
CAGRE001130Medicaid
CAGRE001130Medicaid
CA5804270001Medicare NSC