Provider Demographics
NPI:1700095015
Name:DALE R MASCARI DPM
Entity Type:Organization
Organization Name:DALE R MASCARI DPM
Other - Org Name:THE FOOT CLINIC, PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:MASCARI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-255-1441
Mailing Address - Street 1:5636 N FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4102
Mailing Address - Country:US
Mailing Address - Phone:323-255-1441
Mailing Address - Fax:
Practice Address - Street 1:5636 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-4102
Practice Address - Country:US
Practice Address - Phone:323-255-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1915213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E19151Medicaid
ND5502750001Medicare NSC
CA000E19151Medicaid