Healthcare Provider Details

I. General information

NPI: 1932290178
Provider Name (Legal Business Name): ASSOCIATED PODIATRY GROUP OF SAN CARLOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 LAUREL ST SUITE 100
SAN CARLOS CA
94070-3949
US

IV. Provider business mailing address

961 LAUREL ST SUITE 100
SAN CARLOS CA
94070-3949
US

V. Phone/Fax

Practice location:
  • Phone: 650-593-8083
  • Fax: 650-593-9145
Mailing address:
  • Phone: 650-593-8083
  • Fax: 650-593-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3224
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberE3224
License Number StateCA

VIII. Authorized Official

Name: DR. CURTIS D. LEVIANT
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 650-593-8083