1912085069 NPI number — FOOT AND ANKLE INSTITUTE OF THE WEST

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 1912085069 NPI number — FOOT AND ANKLE INSTITUTE OF THE WEST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE INSTITUTE OF THE WEST
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:
1912085069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18433 ROSCOE BLVD STE 214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91325-4123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-623-4455
Provider Business Mailing Address Fax Number:
818-691-7099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25272 MCINTYRE ST STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-5449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
186-234-4558
Provider Business Practice Location Address Fax Number:
818-691-7099
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FAURIA
Authorized Official First Name:
QUINN
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
818-623-4455

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  BUS0301512 , 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)





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