Provider Demographics
NPI:1477654614
Name:ALBERTY, BYRON SCOTT (DPM)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:SCOTT
Last Name:ALBERTY
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 1:15141 WHITTIER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2135
Mailing Address - Country:US
Mailing Address - Phone:562-789-0444
Mailing Address - Fax:562-789-7309
Practice Address - Street 1:15141 WHITTIER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2135
Practice Address - Country:US
Practice Address - Phone:562-789-0444
Practice Address - Fax:562-789-7309
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4178213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41780Medicaid
CAWE4178AMedicare PIN
CAU79483Medicare UPIN