Foot and Ankle Wellness Clinic

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

E4429 Issued in CA

Legal business name

FOOT AND ANKLE WELLNESS CLINIC

Practice address

6310 San Vicente Blvd Ste 220
Los Angeles, CA 90048-5458

Phone

(323) 937-6903

Fax

(323) 210-7171

NPI assigned

Dec 27, 2007

Last updated

Sep 2, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Suzanne Lee Mancherian, DPMNPI 1427129741

Title

President

Phone

(323) 937-6903

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Tax ID family

Foot and Ankle Wellness Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Foot and Ankle Wellness Clinic

  • Foot Surgery Podiatrist
  • Glendale, CA
  • NPI 1154588556
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Suzanne Lee Mancherian, DPM

  • Podiatrist
  • Los Angeles, CA
  • NPI 1427129741
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1235313123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6310 SAN VICENTE BLVD STE 220",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485458",
            "telephone_number": "323-937-6903",
            "fax_number": "323-210-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6310 SAN VICENTE BLVD STE 220",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485458",
            "telephone_number": "323-937-6903",
            "fax_number": "323-210-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT AND ANKLE WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "MANCHERIAN",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-937-6903",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "CA",
            "license": "E4429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E28430",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Marie Fontes, BS
• Sylvia Fonticiella
• Matthew Joshua Fontila
• Food and Mirth
• Foot & Ankle Champions Incd
• Dingle Foote, M.D.
• Katherine Footracer, PA-C
• Deloid Foots Sr.
• Marina Foox, RPH
• For Life Home Health Care Inc.

• Foot Surgery Podiatrist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Foot Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.