Provider Demographics
NPI:1790471415
Name:TOLUCA LAKE FOOT INSTITUTE INC
Entity Type:Organization
Organization Name:TOLUCA LAKE FOOT INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHRANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-488-6076
Mailing Address - Street 1:10916 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2210
Mailing Address - Country:US
Mailing Address - Phone:818-488-6076
Mailing Address - Fax:818-210-0281
Practice Address - Street 1:10916 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2210
Practice Address - Country:US
Practice Address - Phone:818-488-6076
Practice Address - Fax:818-210-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty