Basic Information
| Provider Information | |||||||||
| NPI: | 1992757603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEUMAN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | |||||||||
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| Credential: | PODIATRIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9017 RESEDA BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913243922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188858400 | ||||||||
| FaxNumber: | 8188855765 | ||||||||
| Practice Location | |||||||||
| Address1: | 1672 W AVENUE J | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188858400 | ||||||||
| FaxNumber: | 8188855765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 05/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | E1584 | CA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 000E15842 | 05 | CA | MEDICAID |