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Organization

ACCESS WOUND CARE AND PODIATRY CARE CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHARLES BLAINE DPM (DPM)
(800) 480-3338
Entity
Organization

Contact information

Practice address
1510 S CENTRAL AVE, SUITE 120, GLENDALE, CA 91204-2500
(800) 480-3338
(818) 790-3121
Mailing address
1510 S. CENTRAL AVE, SUITE 120, GLENDALE, CA 91204
(800) 480-3338
(818) 790-3121

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E3817
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000E38170
CA
Enumeration date
03/13/2009
Last updated
03/13/2009
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