Provider Demographics
NPI:1043741358
Name:GARVEY PODIATRY CLINIC, A PC
Entity Type:Organization
Organization Name:GARVEY PODIATRY CLINIC, A PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-361-7055
Mailing Address - Street 1:10138 GARVEY AVE
Mailing Address - Street 2:SUITE #C
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-5012
Mailing Address - Country:US
Mailing Address - Phone:626-361-7055
Mailing Address - Fax:626-768-7112
Practice Address - Street 1:10138 GARVEY AVE
Practice Address - Street 2:SUITE #C
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-5012
Practice Address - Country:US
Practice Address - Phone:626-361-7055
Practice Address - Fax:626-768-7112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARVEY PODIATRY CLINIC, A PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5164213E00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE5164OtherMEDICAL BOARD
CAE5164OtherMEDICAL BOARD