Organization
FOOT AND ANKLE WELLNESS CLINIC
Active
Organization
FOOT AND ANKLE WELLNESS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUZANNE LEE MANCHERIAN DPM (PRESIDENT)
(323) 937-6903
Entity
Organization
Contact information
Practice address
6310 SAN VICENTE BLVD STE 220, LOS ANGELES, CA 90048-5458
(323) 937-6903
(323) 210-7171
Mailing address
6310 SAN VICENTE BLVD STE 220, LOS ANGELES, CA 90048-5458
(323) 937-6903
(323) 210-7171
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
E4429
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E28430
—
CA
Enumeration date
12/27/2007
Last updated
09/02/2021
Update your record
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