Organization
ASSOCIATED FOOT CARE CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LEONARD KNUDSON (PRESIDENT)
(310) 562-6367
Entity
Organization
Contact information
Practice address
9808 VENICE BLVD STE 600, CULVER CITY, CA 90232-6807
(310) 876-1579
Mailing address
PO BOX 368, CULVER CITY, CA 90232-0368
(310) 562-6367
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
FNP8741
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GRE001550
—
CA
01
—
W14771
RAILROAD MEDICARE
CA
01
—
ZZZ60306Z
BLUE SHIELD
CA
Enumeration date
08/21/2006
Last updated
02/26/2021
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