Healthcare Provider Details

I. General information

NPI: 1568715225
Provider Name (Legal Business Name): ANDREW JAMES FELFOLDI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 KENYON ST. SUITE 502
SAN DIEGO CA
92110
US

IV. Provider business mailing address

3405 KENYON ST. SUITE 502
SAN DIEGO CA
92110
US

V. Phone/Fax

Practice location:
  • Phone: 619-225-9601
  • Fax: 619-225-9606
Mailing address:
  • Phone: 619-225-9601
  • Fax: 619-225-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE5203
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135000788
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: