Provider Demographics
NPI:1891570503
Name:MAIJALA PODIATRY CORPORATION
Entity type:Organization
Organization Name:MAIJALA PODIATRY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MAIJALA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:657-441-1484
Mailing Address - Street 1:3340 W BALL RD STE G
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3729
Mailing Address - Country:US
Mailing Address - Phone:651-441-1484
Mailing Address - Fax:888-440-1680
Practice Address - Street 1:3340 W BALL RD STE G
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3729
Practice Address - Country:US
Practice Address - Phone:651-441-1484
Practice Address - Fax:888-440-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty