Healthcare Provider Details

I. General information

NPI: 1407904501
Provider Name (Legal Business Name): JOHN D SANGUEZA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 KNOWLES DR STE. 220
LOS GATOS CA
95032-1549
US

IV. Provider business mailing address

555 KNOWLES DR STE. 220
LOS GATOS CA
95032-1549
US

V. Phone/Fax

Practice location:
  • Phone: 650-906-8502
  • Fax: 408-379-2672
Mailing address:
  • Phone: 650-906-8502
  • Fax: 408-379-2672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: