Organization
P.B. NIKRAVESH DPM, APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVETTE URETA (MEDICAL ASSISTANT)
(323) 782-8586
Entity
Organization
Contact information
Practice address
6404 WILSHIRE BLVD STE 600, LOS ANGELES, CA 90048-5501
(323) 782-8586
(323) 782-8528
Mailing address
6404 WILSHIRE BLVD STE 600, LOS ANGELES, CA 90048-5501
(323) 782-8586
(323) 782-8528
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
E4103
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
E4103
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E41032
—
CA
01
—
E4103
MEDICARE PTAN
CA
Enumeration date
07/16/2012
Last updated
07/16/2012
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