Provider Demographics
NPI:1770687048
Name:B. DAVID MASSABAND, DPM, INC
Entity Type:Organization
Organization Name:B. DAVID MASSABAND, DPM, INC
Other - Org Name:TOWER PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEHNAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MASSABAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-657-2828
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 705
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-789-7891
Mailing Address - Fax:818-789-7912
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 705
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-789-7891
Practice Address - Fax:818-789-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3989213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU57901Medicare UPIN