Healthcare Provider Details

I. General information

NPI: 1013979103
Provider Name (Legal Business Name): SERRAMONTE PODIATRY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SULLIVAN AVE RM 401
DALY CITY CA
94015-2224
US

IV. Provider business mailing address

901 CAMPUS DR STE 311
DALY CITY CA
94015-4900
US

V. Phone/Fax

Practice location:
  • Phone: 650-755-3338
  • Fax: 650-755-7892
Mailing address:
  • Phone: 650-756-8194
  • Fax: 650-756-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE18120
License Number StateCA

VIII. Authorized Official

Name: DR. BRUCE M DOBBS
Title or Position: OWNER
Credential: DPM
Phone: 650-756-8194