Provider Demographics
NPI:1891809554
Name:THOMAS F. CLEMENTE, DPM INC & JOHN D. HALEBIAN, DPM PTRS
Entity Type:Organization
Organization Name:THOMAS F. CLEMENTE, DPM INC & JOHN D. HALEBIAN, DPM PTRS
Other - Org Name:SCV PODIATRY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GORDON-BARRETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-290-2857
Mailing Address - Street 1:23929 MCBEAN PKWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4466
Mailing Address - Country:US
Mailing Address - Phone:661-290-2857
Mailing Address - Fax:661-290-2880
Practice Address - Street 1:23929 MCBEAN PKWY STE 212
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4468
Practice Address - Country:US
Practice Address - Phone:661-290-2857
Practice Address - Fax:661-290-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2604213ES0131X
CAE2819213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023091808OtherINDIVIDUAL NPI NUMBER/ JOHN D. HALEBIAN, DPM
CA1497755110OtherINDIVIDUAL NPI NUMBER/THOMAS F. CLEMENTE, DPM
CA1081000001Medicare NSC
CAT19240Medicare UPIN
CA1497755110OtherINDIVIDUAL NPI NUMBER/THOMAS F. CLEMENTE, DPM
CAT19211Medicare UPIN
CAW13689Medicare ID - Type UnspecifiedJOHN HALEBIAN, DPM