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Individual

BEHROOZ DAVID SOOFER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
10379 EASTBORNE AVE, LOS ANGELES, CA 90024-5364
(310) 430-8870
(323) 432-0860
Mailing address
10379 EASTBORNE AVE, LOS ANGELES, CA 90024-5364
(310) 430-8870
(323) 432-0860

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E4059
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000E40591
BLUESHIELD
CA
05
000E40592
CA
01
480031462
MEDICARE RAILROAD
CA
01
E4059
BLUE CROSS
CA
01
E4059
LICENSE NUMBER
Enumeration date
09/07/2005
Last updated
11/18/2023
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