Provider Demographics
NPI:1548560766
Name:MY FOOT CLINIC, INC
Entity Type:Organization
Organization Name:MY FOOT CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:POURMOUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-344-6300
Mailing Address - Street 1:18909 SHERMAN WAY
Mailing Address - Street 2:B
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-7700
Mailing Address - Country:US
Mailing Address - Phone:818-344-6300
Mailing Address - Fax:818-774-9719
Practice Address - Street 1:18909 SHERMAN WAY
Practice Address - Street 2:B
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-7700
Practice Address - Country:US
Practice Address - Phone:818-344-6300
Practice Address - Fax:818-774-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty