Provider Demographics
NPI:1619271616
Name:POUGATSCH, DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:POUGATSCH
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 1:9663 SANTA MONICA BLVD # 1151
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-919-4179
Mailing Address - Fax:877-239-0994
Practice Address - Street 1:250 N ROBERTSON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1767
Practice Address - Country:US
Practice Address - Phone:310-919-4179
Practice Address - Fax:877-239-0994
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4977213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB247801Medicare PIN