MEDICARE: INLAND PODIATRY CENTER PROFESSIONAL CORPORATION

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E1457	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	E1457	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1356557581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND PODIATRY CENTER PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	9474 BASELINE RD
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91701-5822
Country	:	US
Telephone Number	:	909-987-3211
Fax Number	:	909-987-0317

Provider Business Practice Location Address
First Line	:	9474 BASELINE RD
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91701-5822
Country	:	US
Telephone Number	:	909-987-3211
Fax Number	:	909-987-0317

Authorized Official
Title or Position	:	OWNER,PODIATRIST
Name	:	DR. WILLIAM C. LANDREY
Credential	:	D.P.M.
Telephone Number	:	909-987-3211

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	04/06/2015

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