Provider Demographics
NPI:1164650206
Name:JUSSAL, TINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:JUSSAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1038 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-771-4191
Mailing Address - Fax:714-771-2731
Practice Address - Street 1:1038 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:914-771-4191
Practice Address - Fax:714-771-2731
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5022213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery