Healthcare Provider Details

I. General information

NPI: 1861819476
Provider Name (Legal Business Name): ROGER TSUTSUMI DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 MAGNOLIA AVE
RIVERSIDE CA
92504-3863
US

IV. Provider business mailing address

7111 MAGNOLIA AVE STE 100
RIVERSIDE CA
92504-3842
US

V. Phone/Fax

Practice location:
  • Phone: 951-359-8802
  • Fax: 951-359-8802
Mailing address:
  • Phone: 951-359-8800
  • Fax: 951-359-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4188
License Number StateCA

VIII. Authorized Official

Name: ROGER TSUTSUMI
Title or Position: OWNER
Credential: D.P.M.
Phone: 951-359-8800