Basic Information
| Provider Information | |||||||||
| NPI: | 1154055176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUM | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | DALE | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 252 MARIPOSA AVE | ||||||||
| Address2: | APT D | ||||||||
| City: | SIERRA MADRE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039109137 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WHITE MEMORIAL HOSPITAL 1720 CESAR CHAVEZ AVENUE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232685000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2022 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | EL7071 | CA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.