1639234446 NPI number — PODIATRY ASSOCIATES OF SAN DIEGO COUNTY, INC.

Table of content: (NPI 1639234446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639234446 NPI number — PODIATRY ASSOCIATES OF SAN DIEGO COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY ASSOCIATES OF SAN DIEGO COUNTY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639234446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3330 3RD AVE
Provider Second Line Business Mailing Address:
SUITE 402
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-5639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-298-1733
Provider Business Mailing Address Fax Number:
619-294-9604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 EUCLID AVE
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-2957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-472-0252
Provider Business Practice Location Address Fax Number:
619-294-9604
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAUBMAN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
619-298-1733

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  E2237 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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