Provider Demographics
NPI:1497076962
Name:KORSNACK, ROTEM (DPM)
Entity Type:Individual
Prefix:
First Name:ROTEM
Middle Name:
Last Name:KORSNACK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HILLSDALE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0101
Mailing Address - Country:US
Mailing Address - Phone:949-933-3434
Mailing Address - Fax:
Practice Address - Street 1:3851 KATELLA AVE STE 255
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3353
Practice Address - Country:US
Practice Address - Phone:562-431-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5040213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty