Unknown Individual – Podiatrist, NPI 1396776092

Unknown Individual is a healthcare provider. based in Encino, California. specializing in Podiatrist. They hold a License No. E1542 (CA). The NPI Number for Unknown Individual is 1396776092

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1396776092
Phone
(818) 783-3338
Address
17200 VENTURA BLVD STE 207
Deactivation Date
5 December 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1971 (55 years ago)
PAC ID
5698937316
Professional Enrollment ID
I20120425000642
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 17200 VENTURA BLVD STE 207

    SUITE 110

    ENCINO, CA 913164096

    Phone: (818) 783-3338

    Fax: (818) 583-1444

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 91316)

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Provider's Procedures

Unknown Individual performs procedures in Podiatrist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PODIATRYCA11056Removal of 2 to 4 thickened skin growths370146

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1396776092.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Podiatrist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Encino, California because that is what the record indicates for Unknown Individual.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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