Provider Demographics
NPI:1851492417
Name:FOOT & ANKLE CLINIC INC
Entity Type:Organization
Organization Name:FOOT & ANKLE CLINIC INC
Other - Org Name:VALENCIA FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER /PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AVAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:661-288-2321
Mailing Address - Street 1:23206 LYONS AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1111
Mailing Address - Country:US
Mailing Address - Phone:661-288-2321
Mailing Address - Fax:661-288-0378
Practice Address - Street 1:23206 LYONS AVE
Practice Address - Street 2:STE 108
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2667
Practice Address - Country:US
Practice Address - Phone:661-288-2321
Practice Address - Fax:661-288-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4191213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U73271Medicare UPIN
CAW16338Medicare PIN