Provider Demographics
NPI:1043961360
Name:RASOOLI PODIATRY CORPORATION
Entity type:Organization
Organization Name:RASOOLI PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ETHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-223-3314
Mailing Address - Street 1:29734 GRANDPOINT LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6422
Mailing Address - Country:US
Mailing Address - Phone:909-223-3314
Mailing Address - Fax:
Practice Address - Street 1:50 ROCKINGHORSE RD
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-6565
Practice Address - Country:US
Practice Address - Phone:916-300-9832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty