Provider Demographics
NPI:1417579129
Name:CENTRAL CALIFORNIA LEG, FOOT, AND ANKLE CENTER, INC.
Entity Type:Organization
Organization Name:CENTRAL CALIFORNIA LEG, FOOT, AND ANKLE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GHORBANIFARAJZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-310-8155
Mailing Address - Street 1:217 REGAL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27462 PORTOLA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92610-2838
Practice Address - Country:US
Practice Address - Phone:949-468-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty