Provider Demographics
NPI:1205387461
Name:EMPIRE FOOT AND ANKLE CENTER INC.
Entity Type:Organization
Organization Name:EMPIRE FOOT AND ANKLE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RABIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-515-8155
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3586
Mailing Address - Country:US
Mailing Address - Phone:310-515-8155
Mailing Address - Fax:310-515-8833
Practice Address - Street 1:299 W FOOTHILL BLVD
Practice Address - Street 2:124
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3804
Practice Address - Country:US
Practice Address - Phone:909-946-6643
Practice Address - Fax:909-946-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty