Provider Demographics
NPI:1780215210
Name:ALBERT ELHIANI DPM INC
Entity Type:Organization
Organization Name:ALBERT ELHIANI DPM INC
Other - Org Name:EAZY FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELHIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:424-279-9332
Mailing Address - Street 1:9340 W PICO BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1255
Mailing Address - Country:US
Mailing Address - Phone:510-457-1463
Mailing Address - Fax:310-288-1774
Practice Address - Street 1:9233 W PICO BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1385
Practice Address - Country:US
Practice Address - Phone:424-279-9332
Practice Address - Fax:424-279-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699298539Medicaid