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NPI Code Detail

MEDICARE: DR. JUAN RODERICK BALZA PAGSOLINGAN D.P.M.

MEDICARE: DR. JUAN RODERICK BALZA PAGSOLINGAN D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatristE4169CA
2213ES0103XFoot & Ankle Surgery PodiatristE4169CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063498749
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN RODERICK BALZA PAGSOLINGAN D.P.M.
Provider Business Mailing Address
First Line : 210 CANAL ST
Second Line :
City : KING CITY
State : CA
Zip : 93930-3432
Country : US
Telephone Number : 831-385-5471
Fax Number : 831-385-5940
Provider Business Practice Location Address
First Line : 210 CANAL ST
Second Line :
City : KING CITY
State : CA
Zip : 93930-3432
Country : US
Telephone Number : 831-385-5471
Fax Number : 831-385-5940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 11/09/2015

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