Provider Demographics
NPI:1669670279
Name:PODIATRY INSTITUTE OF SOUTHERN CALIFORNIA INC.
Entity Type:Organization
Organization Name:PODIATRY INSTITUTE OF SOUTHERN CALIFORNIA INC.
Other - Org Name:PODIATRY INSTITUTE OF SOUTHERN CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEJAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-204-2300
Mailing Address - Street 1:9808 VENICE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6807
Mailing Address - Country:US
Mailing Address - Phone:310-204-2300
Mailing Address - Fax:310-204-0444
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6807
Practice Address - Country:US
Practice Address - Phone:310-204-2300
Practice Address - Fax:310-204-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4400213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21414Medicare Oscar/Certification
CA5973680001Medicare NSC