Provider Demographics
NPI:1205937133
Name:LA, ANDREW C (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:LA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1510 S CENTRAL AVE #120
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2577
Mailing Address - Country:US
Mailing Address - Phone:818-242-3668
Mailing Address - Fax:818-242-2425
Practice Address - Street 1:1510 S CENTRAL AVE #120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2577
Practice Address - Country:US
Practice Address - Phone:818-242-3668
Practice Address - Fax:818-242-2425
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4312213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E43121Medicaid
CA000E43120Medicaid
CA000E43122Medicaid
CA000E43122Medicaid
CAE4312Medicare ID - Type Unspecified
CA000E43120Medicaid
CA000E43121Medicaid