Provider Demographics
NPI:1649691254
Name:TEMPLE FOOT CLINIC INC
Entity type:Organization
Organization Name:TEMPLE FOOT CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:661-322-5900
Mailing Address - Street 1:1326 H ST
Mailing Address - Street 2:1
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5134
Mailing Address - Country:US
Mailing Address - Phone:661-322-5900
Mailing Address - Fax:661-322-5901
Practice Address - Street 1:1326 H ST
Practice Address - Street 2:1
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5134
Practice Address - Country:US
Practice Address - Phone:661-322-5900
Practice Address - Fax:661-322-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4361213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4361OtherMEDICAL LICENSE