Provider Demographics
NPI:1033198940
Name:VALLEY FOOT HEALTH CTR INC
Entity Type:Organization
Organization Name:VALLEY FOOT HEALTH CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAINKAMP
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-716-6964
Mailing Address - Street 1:22110 ROSCOE BLVD
Mailing Address - Street 2:#201
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3845
Mailing Address - Country:US
Mailing Address - Phone:818-716-6964
Mailing Address - Fax:818-716-1530
Practice Address - Street 1:22110 ROSCOE BLVD
Practice Address - Street 2:#201
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-3845
Practice Address - Country:US
Practice Address - Phone:818-716-6964
Practice Address - Fax:818-716-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2355213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11302Medicare UPIN
WE8611Medicare ID - Type Unspecified