Organization
NEW AGE FOOT AND ANKLE PODIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEKSANDER V LAVRENOV D.P.M. (PRESIDENT)
(917) 687-7528
Entity
Organization
Contact information
Practice address
705 IVY STREET, GLENDALE, CA 91204
(917) 687-7528
Mailing address
20548 VENTURA BLVD, APT 217, WOODLAND HILLS, CA 91364-6225
(917) 687-7528
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E 5019
CA
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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