Healthcare Provider Details

I. General information

NPI: 1851546790
Provider Name (Legal Business Name): MARIE M SAINT LOUIS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E WALNUT ST FL 3
PASADENA CA
91188-0001
US

IV. Provider business mailing address

393 E WALNUT ST FL 3
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 917-727-4302
  • Fax:
Mailing address:
  • Phone: 917-727-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberN006331-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE4952
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006331-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: