Provider Demographics
NPI:1730661620
Name:ABDELMALAK PODIATRY CORP
Entity Type:Organization
Organization Name:ABDELMALAK PODIATRY CORP
Other - Org Name:EL MONTE FAMILY PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELMALAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-343-0820
Mailing Address - Street 1:3503 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2607
Mailing Address - Country:US
Mailing Address - Phone:626-442-1223
Mailing Address - Fax:626-442-0439
Practice Address - Street 1:3503 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2607
Practice Address - Country:US
Practice Address - Phone:626-442-1223
Practice Address - Fax:626-442-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5416213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty