Provider Demographics
NPI:1790713493
Name:GAROFALO, FRANK J (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:J
Last Name:GAROFALO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N PACIFIC AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-4313
Mailing Address - Country:US
Mailing Address - Phone:818-552-5000
Mailing Address - Fax:818-956-0990
Practice Address - Street 1:1101 N PACIFIC AVE STE 104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-4313
Practice Address - Country:US
Practice Address - Phone:818-552-5000
Practice Address - Fax:818-956-0990
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1174213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE0011741OtherMEDICAL PROVIDER
CAE0011741OtherMEDICAL PROVIDER
CAE1174AMedicare ID - Type UnspecifiedPROVIDER NUMBER
CAAG4483044OtherDEA NUMBER