1053582239 NPI number — BARRY A. WERTHEIMER, DPM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053582239 NPI number — BARRY A. WERTHEIMER, DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRY A. WERTHEIMER, DPM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053582239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3571 LARIAT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROLLING HILLS ESTATES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90274-2518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-544-3318
Provider Business Mailing Address Fax Number:
310-541-0168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2850 ARTESIA BLVD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
REDONDO BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90278-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-530-0544
Provider Business Practice Location Address Fax Number:
310-793-1161
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WERTHEIMER
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
ARMANE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-530-0544

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  E1248 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18617413379 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com