Provider Demographics
NPI:1649740556
Name:FOOT AND ANKLE CARE TEAM INC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CARE TEAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RABIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-515-8155
Mailing Address - Street 1:5365 WALNUT AVE STE M
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2622
Mailing Address - Country:US
Mailing Address - Phone:909-946-6643
Mailing Address - Fax:909-946-6130
Practice Address - Street 1:5365 WALNUT AVE STE M
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2622
Practice Address - Country:US
Practice Address - Phone:909-946-6643
Practice Address - Fax:909-946-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty