Provider Demographics
NPI:1356303432
Name:VANVOOREN, MARY ELIZABETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:VANVOOREN
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:1045 ATLANTIC AVE
Mailing Address - Street 2:SUITE 807
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3414
Mailing Address - Country:US
Mailing Address - Phone:562-437-3338
Mailing Address - Fax:562-437-1919
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:SUITE 807
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3408
Practice Address - Country:US
Practice Address - Phone:562-437-3338
Practice Address - Fax:562-437-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2021-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE4551213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E45510Medicaid
5282250001Medicare NSC
CAU99868Medicare UPIN
CAE4551Medicare PIN