Healthcare Provider Details

I. General information

NPI: 1922039965
Provider Name (Legal Business Name): CHRISTOPHER J. FENESY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 MIRAMONTE AVE STE 7
MOUNTAIN VIEW CA
94040-3718
US

IV. Provider business mailing address

1704 MIRAMONTE AVE STE 7
MOUNTAIN VIEW CA
94040-3718
US

V. Phone/Fax

Practice location:
  • Phone: 650-625-8711
  • Fax: 650-625-8727
Mailing address:
  • Phone: 650-625-8711
  • Fax: 650-625-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000E25060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: