Provider Demographics
NPI:1790762573
Name:POURKARAM, NANCY T (DPM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:T
Last Name:POURKARAM
Suffix:
Gender:F
Credentials:DPM
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2936 PERSIMMON PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2219
Mailing Address - Country:US
Mailing Address - Phone:714-547-9668
Mailing Address - Fax:714-879-9803
Practice Address - Street 1:1905 E 17TH ST
Practice Address - Street 2:SUITE 312
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8628
Practice Address - Country:US
Practice Address - Phone:714-547-9668
Practice Address - Fax:714-879-9803
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4438213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist