Provider Demographics
NPI:1043366776
Name:DIABETIC NEUROPATHY & FOOTCARE INSTITUTE OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:DIABETIC NEUROPATHY & FOOTCARE INSTITUTE OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVRON
Authorized Official - Middle Name:
Authorized Official - Last Name:DANILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-345-3338
Mailing Address - Street 1:18411 CLARK ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3506
Mailing Address - Country:US
Mailing Address - Phone:818-345-3338
Mailing Address - Fax:818-345-3363
Practice Address - Street 1:18411 CLARK ST
Practice Address - Street 2:SUITE 105
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3506
Practice Address - Country:US
Practice Address - Phone:818-345-3338
Practice Address - Fax:818-345-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty