Healthcare Provider Details

I. General information

NPI: 1891611414
Provider Name (Legal Business Name): JEREMY ANDRUS SKELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5182
US

IV. Provider business mailing address

1334 STATICE CT
CARLSBAD CA
92011-1272
US

V. Phone/Fax

Practice location:
  • Phone: 858-227-6894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL7243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: