Provider Demographics
NPI:1659407120
Name:VALLEY FOOT SURGEONS, A PODIATRY GROUP, INC.
Entity Type:Organization
Organization Name:VALLEY FOOT SURGEONS, A PODIATRY GROUP, INC.
Other - Org Name:VALLEY FOOT SURGEONS, A PODIATRY GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT, SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GILMAN KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-342-1600
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-0972
Mailing Address - Country:US
Mailing Address - Phone:818-342-1600
Mailing Address - Fax:818-342-1609
Practice Address - Street 1:18411 CLARK ST
Practice Address - Street 2:SUITE 107
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3506
Practice Address - Country:US
Practice Address - Phone:818-342-1600
Practice Address - Fax:818-342-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2775213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18040Medicare ID - Type UnspecifiedMEDICARE GROUP
CA5334410001Medicare NSC