Organization
THE DIABETIC SHOE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER A OTIKO DPM (CEO)
(818) 766-6776
Entity
Organization
Contact information
Practice address
10639 BURBANK BLVD, N HOLLYWOOD, CA 91601-2512
(866) 712-7463
(818) 508-1819
Mailing address
10639 BURBANK BLVD, N HOLLYWOOD, CA 91601-2512
(866) 712-7463
(818) 508-1819
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
E4159
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4875930001
DMERC
—
Enumeration date
12/16/2005
Last updated
08/22/2020
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