Healthcare Provider Details

I. General information

NPI: 1598860256
Provider Name (Legal Business Name): FEDRIGO PODIATRY, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SIR FRANCIS DRAKE BLVD STE 1
KENTFIELD CA
94904-1418
US

IV. Provider business mailing address

1125 SIR FRANCIS DRAKE BLVD STE 1
KENTFIELD CA
94904-1418
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-6555
  • Fax: 415-461-6556
Mailing address:
  • Phone: 415-461-6555
  • Fax: 415-461-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY J FEDRIGO
Title or Position: OWNER
Credential: DPM
Phone: 415-331-4500