Provider Demographics
NPI:1033349220
Name:PACIFIC FOOT AND ANKLE ASSOCIATES
Entity Type:Organization
Organization Name:PACIFIC FOOT AND ANKLE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGHOORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-385-3338
Mailing Address - Street 1:150 W FOOTHILL BLVD UNIT F
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1103
Mailing Address - Country:US
Mailing Address - Phone:626-385-3388
Mailing Address - Fax:626-914-4119
Practice Address - Street 1:150 W FOOTHILL BLVD UNIT F
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1103
Practice Address - Country:US
Practice Address - Phone:626-385-3388
Practice Address - Fax:626-914-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4526213ES0103X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1741339Medicaid
CACR209AMedicare PIN
CACR211AMedicare PIN
CA1741339Medicaid