Provider Demographics
NPI:1689066581
Name:VALLEY FOOT CLINIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VALLEY FOOT CLINIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CINTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:818-784-8420
Mailing Address - Street 1:14600 SHERMAN WAY STE 230
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2291
Mailing Address - Country:US
Mailing Address - Phone:818-519-2294
Mailing Address - Fax:
Practice Address - Street 1:14600 SHERMAN WAY STE 230
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2291
Practice Address - Country:US
Practice Address - Phone:818-784-8420
Practice Address - Fax:818-785-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4452213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty