Provider Demographics
NPI:1760550735
Name:DAVID G. LITTLE D.P.M., INC.
Entity Type:Organization
Organization Name:DAVID G. LITTLE D.P.M., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-283-4449
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-0297
Mailing Address - Country:US
Mailing Address - Phone:310-283-4449
Mailing Address - Fax:310-337-7540
Practice Address - Street 1:7768 3/4 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6219
Practice Address - Country:US
Practice Address - Phone:310-283-4449
Practice Address - Fax:818-230-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3767213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760550735Medicaid
CA000E37670Medicaid
CA4001130001Medicare NSC