Provider Demographics
NPI:1508965286
Name:FASS, ARTHUR HUGH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:HUGH
Last Name:FASS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18250 ROSCOE BLVD
Mailing Address - Street 2:STE 125
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-701-5088
Mailing Address - Fax:818-701-1602
Practice Address - Street 1:18250 ROSCOE BLVD STE 125
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4266
Practice Address - Country:US
Practice Address - Phone:818-701-5088
Practice Address - Fax:818-701-1602
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2475213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E24751Medicaid
CA000E24751Medicaid
CAE2475Medicare PIN
T11348Medicare PIN