# PRAIRIE AVENUE PODIATRY GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275068967
- **Authorized official:** MRS. BEVERLY STEPHENS (SECRETARY)
- **Authorized official phone:** (310) 671-5800

## Contact information

- **Practice address:** 323 N PRAIRIE AVE, SUITE 320, INGLEWOOD, CA 90301-4502
- **Practice address phone:** (310) 671-5800
- **Practice address fax:** (310) 671-5810
- **Mailing address:** 323 N PRAIRIE AVE STE 320, INGLEWOOD, CA 90301-4505
- **Mailing address phone:** (310) 671-5800
- **Mailing address fax:** (310) 671-5810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | E2206 | CA | Yes |

## Other

- **Enumeration date:** 05/01/2017
- **Last updated:** 01/09/2023