Provider Demographics
NPI:1033245691
Name:YOSEF FREEDLAND A PROFESSIONAL PODIATRIC CORPORATION
Entity Type:Organization
Organization Name:YOSEF FREEDLAND A PROFESSIONAL PODIATRIC CORPORATION
Other - Org Name:LASER FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:FREEDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-655-3668
Mailing Address - Street 1:8215 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4505
Mailing Address - Country:US
Mailing Address - Phone:323-655-3668
Mailing Address - Fax:323-655-3819
Practice Address - Street 1:8215 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4505
Practice Address - Country:US
Practice Address - Phone:323-655-3668
Practice Address - Fax:323-655-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2962261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19309ZOtherBLUE SHIELD
CA000E29620Medicaid
CA0298310001OtherDMERC
CA000E29620Medicaid
CAE2962Medicare ID - Type Unspecified