Provider Demographics
NPI:1083926729
Name:GILMAN PODIATRY, A PROF. CORP
Entity Type:Organization
Organization Name:GILMAN PODIATRY, A PROF. CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES. SEC.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GILMAN KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-905-1000
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-0972
Mailing Address - Country:US
Mailing Address - Phone:818-905-1000
Mailing Address - Fax:818-342-1609
Practice Address - Street 1:17777 VENTURA BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3736
Practice Address - Country:US
Practice Address - Phone:818-905-1000
Practice Address - Fax:818-342-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2775213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty