Provider Demographics
NPI:1689716763
Name:POWERS, TODD A
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:POWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 MONTEZUMA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3229
Mailing Address - Country:US
Mailing Address - Phone:310-497-3580
Mailing Address - Fax:310-497-3580
Practice Address - Street 1:11800 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3040
Practice Address - Country:US
Practice Address - Phone:626-401-2775
Practice Address - Fax:626-401-9826
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4118213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41180Medicare ID - Type Unspecified
CAU70568Medicare UPIN
CA1234060001Medicare NSC