Provider Demographics
NPI:1689744666
Name:WEST COAST FOOT AND ANKLE PODIATRIC MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:WEST COAST FOOT AND ANKLE PODIATRIC MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEAMING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-986-6886
Mailing Address - Street 1:1760 TERMINO AVE
Mailing Address - Street 2:309
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2105
Mailing Address - Country:US
Mailing Address - Phone:562-986-6886
Mailing Address - Fax:
Practice Address - Street 1:1760 TERMINO AVE
Practice Address - Street 2:309
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2105
Practice Address - Country:US
Practice Address - Phone:562-986-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4395213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4395OtherDR. LICENSE
CAU90844OtherUPN
CAU90844OtherUPN
CAGF446AMedicare PIN