Provider Demographics
NPI:1053678078
Name:UNIVERSAL FOOT AND ANKLE CARE, A PODIATRY CORPORATION
Entity Type:Organization
Organization Name:UNIVERSAL FOOT AND ANKLE CARE, A PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYMAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOSHYARSAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-723-7862
Mailing Address - Street 1:PO BOX 280748
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91328-0748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11800 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3040
Practice Address - Country:US
Practice Address - Phone:818-723-7862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4547213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty