Access Wound Care and Podiatry Care Clinic

Primary specialty

PodiatristTaxonomy code 213E00000X

License

E3817 Issued in CA

Legal business name

ACCESS WOUND CARE AND PODIATRY CARE CLINIC

Practice address

1510 S Central Ave
Suite 120
Glendale, CA 91204-2500

Phone

(800) 480-3338

Fax

(818) 790-3121

NPI assigned

Mar 13, 2009

Organization subpart

No

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

Authorized official

Name

Charles Blaine, DPM

Title

DPM

Phone

(800) 480-3338

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1236902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236902400000",
    "number": "1679714166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S. CENTRAL AVE",
            "address_2": "SUITE 120",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91204",
            "telephone_number": "800-480-3338",
            "fax_number": "818-790-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE",
            "address_2": "SUITE 120",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042500",
            "telephone_number": "800-480-3338",
            "fax_number": "818-790-3121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS WOUND CARE AND PODIATRY CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-13",
        "last_updated": "2009-03-13",
        "status": "A",
        "authorized_official_last_name": "BLAINE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DPM",
        "authorized_official_telephone_number": "800-480-3338",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E3817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E38170",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Glendale, CA
• Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.