Healthcare Provider Details

I. General information

NPI: 1063753036
Provider Name (Legal Business Name): ANNALISA Y. CO, PODIATRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5931 STANLEY AVE SUITE 8
CARMICHAEL CA
95608-3846
US

IV. Provider business mailing address

1440 KINGSFORD DR
CARMICHAEL CA
95608-6165
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-4389
  • Fax: 916-481-4307
Mailing address:
  • Phone: 916-487-7845
  • Fax: 916-914-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4613
License Number StateCA

VIII. Authorized Official

Name: DR. ANNALISA CO
Title or Position: PODIATRIC SURGEON
Credential: D.P.M.
Phone: 916-487-7845