Organization
FOOTHILL SURGICAL SPECIALISTS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL H. CARVAJAL JR. MD (PRESIDENT/MD)
(818) 243-1135
Entity
Organization
Contact information
Practice address
1560 E. CHEVY CHASE DR., SUITE 430, GLENDALE, CA 91206-4197
(818) 243-1135
(818) 243-9332
Mailing address
1560 E. CHEVY CHASE DR., SUITE 430, GLENDALE, CA 91206-4197
(818) 243-1135
(818) 243-9332
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
02/15/2007
Last updated
01/08/2014
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