Healthcare Provider Details

I. General information

NPI: 1821751736
Provider Name (Legal Business Name): CUPERTINO PODIATRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 LOS GATOS BLVD STE 4
LOS GATOS CA
95032-2028
US

IV. Provider business mailing address

15100 LOS GATOS BLVD STE 4
LOS GATOS CA
95032-2028
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-6234
  • Fax: 408-358-6234
Mailing address:
  • Phone: 408-358-6234
  • Fax: 408-358-6234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JUDY E MANNINA
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 408-489-3414