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PAULS SHOE REPAIR AND SALES INC.
Complete NPI Record 1750573648
Prosthetic/Orthotic Supplier in Glendale, CA

NPI Status: Active since August 14, 2007

Contact Information

1102 S GLENDALE AVE
GLENDALE, CA
ZIP 91205
Phone: (818) 507-0314
Fax: (818) 507-9962

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Title or Position
  24. Authorized Official Telephone Number
  25. Healthcare Provider Taxonomy Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Is Organization Subpart
  28. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1750573648. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1750573648
The telephone number associated with the location address of the provider being identified.
Entity Type Code: 2
The date the provider was assigned a unique identifier (assigned an NPI).
Employer Identification Number EIN: UNAVAIL
The date that a record was last updated or changed.
The code designating the provider’s gender if the provider is a person.
Provider First Line Business Mailing Address: 1102 S GLENDALE AVE
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: GLENDALE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 912053203
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 8185070314
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 8185079962
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1102 S GLENDALE AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: GLENDALE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: CA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 912053203
The date that a record was last updated or changed.
Provider Business Practice Location Address Country Code If outside U S : US
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Provider Business Practice Location Address Telephone Number: 8185070314
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8185079962
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/14/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/2/2020
The date that a record was last updated or changed.
Authorized Official Last Name: MISHIDZHYAN
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MARTIROS
The first name of the authorized official.
Authorized Official Title or Position: PRESIDENT
Authorized Official Telephone Number: 8185070314
Healthcare Provider Taxonomy Code 1: 335E00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
NPI Certification Date: 7/2/2020