Provider Demographics
NPI:1801318597
Name:PROFESSIONAL FOOT AND ANKLE CENTER, INC
Entity type:Organization
Organization Name:PROFESSIONAL FOOT AND ANKLE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERADOUNI NEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-571-5358
Mailing Address - Street 1:2601 W ALAMEDA AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4810
Mailing Address - Country:US
Mailing Address - Phone:818-558-7075
Mailing Address - Fax:818-558-7081
Practice Address - Street 1:28631 S WESTERN AVE STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0816
Practice Address - Country:US
Practice Address - Phone:818-558-7075
Practice Address - Fax:818-558-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4767OtherLICENSE