Organization
PRAIRIE AVENUE PODIATRY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEVERLY STEPHENS (SECRETARY)
(310) 671-5800
Entity
Organization
Contact information
Practice address
323 N PRAIRIE AVE, SUITE 320, INGLEWOOD, CA 90301-4502
(310) 671-5800
(310) 671-5810
Mailing address
323 N PRAIRIE AVE STE 320, INGLEWOOD, CA 90301-4505
(310) 671-5800
(310) 671-5810
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E2206
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB277242
MEDICARE NHIC
CA
Enumeration date
05/01/2017
Last updated
01/09/2023
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