Provider Demographics
NPI:1912373952
Name:DAVID A. POUGATSCH, DPM, INC.
Entity Type:Organization
Organization Name:DAVID A. POUGATSCH, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:POUGATSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-922-2244
Mailing Address - Street 1:9663 SANTA MONICA BLVD # 682
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:818-922-2244
Mailing Address - Fax:
Practice Address - Street 1:250 N ROBERTSON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1767
Practice Address - Country:US
Practice Address - Phone:310-919-4179
Practice Address - Fax:877-239-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4977213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB247802Medicare PIN