Provider Demographics
NPI:1417145525
Name:SLOMOWITZ, LARRY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:SLOMOWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 S. WESTLAKE BLVD.
Mailing Address - Street 2:SUITE 129
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1985
Mailing Address - Country:US
Mailing Address - Phone:805-496-1805
Mailing Address - Fax:805-494-8384
Practice Address - Street 1:1240 S WESTLAKE BLVD
Practice Address - Street 2:SUITE 129
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1929
Practice Address - Country:US
Practice Address - Phone:805-496-1805
Practice Address - Fax:805-494-8384
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1746213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE1746BMedicare PIN
CAWE1746AMedicare PIN
CAT11052Medicare UPIN