MEDICARE: DR. TODD C SELF DPM

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	213E00000X	Podiatrist	E3690	CA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E3690	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

General Provider Information

NPI Number	:	1871569889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD C SELF DPM

Provider Business Mailing Address
First Line	:	940 SYLVA LN STE E
Second Line	:
City	:	SONORA
State	:	CA
Zip	:	95370-5969
Country	:	US
Telephone Number	:	209-533-3996
Fax Number	:	209-533-3998

Provider Business Practice Location Address
First Line	:	940 SYLVA LN STE E
Second Line	:
City	:	SONORA
State	:	CA
Zip	:	95370-5969
Country	:	US
Telephone Number	:	209-533-3996
Fax Number	:	209-533-3998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. TODD C SELF DPM” Practice Location

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