Provider Demographics
NPI:1699185850
Name:ASSURANT FOOT AND ANKLE CARE, SURGERY & AESTHETICS
Entity Type:Organization
Organization Name:ASSURANT FOOT AND ANKLE CARE, SURGERY & AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-412-0183
Mailing Address - Street 1:455 N PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1413
Mailing Address - Country:US
Mailing Address - Phone:310-412-0183
Mailing Address - Fax:
Practice Address - Street 1:160 S LASKY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1704
Practice Address - Country:US
Practice Address - Phone:310-412-0183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4965261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740247766OtherNPI