Provider Demographics
NPI:1669658043
Name:COMPLETE CARE PODIATRY GROUP
Entity Type:Organization
Organization Name:COMPLETE CARE PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:805-646-7163
Mailing Address - Street 1:311 N ROBERTSON BLVD
Mailing Address - Street 2:#677
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13132 STUDEBAKER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2557
Practice Address - Country:US
Practice Address - Phone:562-651-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4302213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty