Healthcare Provider Details

I. General information

NPI: 1235353467
Provider Name (Legal Business Name): ADOBE FOOT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 HIGH SCHOOL AVE STE 222
CONCORD CA
94520-1813
US

IV. Provider business mailing address

15 APRIL CT
PLEASANT HILL CA
94523-2731
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE28440
License Number StateCA

VIII. Authorized Official

Name: CECILE SHEPARD
Title or Position: OWNER
Credential:
Phone: 925-372-8780