Provider Demographics
NPI:1386185650
Name:ARTISAN FOOT AND ANKLE PODIATRIC SPECIALISTS INC
Entity Type:Organization
Organization Name:ARTISAN FOOT AND ANKLE PODIATRIC SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-272-0007
Mailing Address - Street 1:32565 B GOLDEN LANTERN STREET
Mailing Address - Street 2:PMB 341
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3261
Mailing Address - Country:US
Mailing Address - Phone:949-272-0007
Mailing Address - Fax:949-272-0006
Practice Address - Street 1:23141 MOULTON PKWY
Practice Address - Street 2:#109
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1241
Practice Address - Country:US
Practice Address - Phone:949-272-0007
Practice Address - Fax:949-272-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2022-04-14
Deactivation Date:2019-05-16
Deactivation Code:
Reactivation Date:2019-05-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty