Healthcare Provider Details

I. General information

NPI: 1962407882
Provider Name (Legal Business Name): ANTHONY JAMES FEDRIGO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
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 NumberE4298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: