Provider Demographics
NPI:1568576528
Name:CONVALESCENT PODIATRY CARE
Entity Type:Organization
Organization Name:CONVALESCENT PODIATRY CARE
Other - Org Name:CONVALESCENT PODIATRY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-867-0811
Mailing Address - Street 1:5445 DEL AMO BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2761
Mailing Address - Country:US
Mailing Address - Phone:562-867-0811
Mailing Address - Fax:562-866-4046
Practice Address - Street 1:5445 DEL AMO BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2761
Practice Address - Country:US
Practice Address - Phone:562-867-0811
Practice Address - Fax:562-866-4046
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONVALESCENT PODIATRY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-18
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE11149Medicare PIN