Healthcare Provider Details

I. General information

NPI: 1194934331
Provider Name (Legal Business Name): CALIFORNIA FOOT & ANKLE ASSOC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 CAMINO DE LOS MARES, SUITE 304
SAN CLEMENTE CA
92673-2841
US

IV. Provider business mailing address

665 CAMINO DE LOS MARES STE 304
SAN CLEMENTE CA
92673-2841
US

V. Phone/Fax

Practice location:
  • Phone: 949-493-8020
  • Fax: 949-488-0868
Mailing address:
  • Phone: 949-493-8020
  • Fax: 949-488-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3515
License Number StateCA

VIII. Authorized Official

Name: DR. PHILIP A RADOVIC
Title or Position: OWNER
Credential: DPM
Phone: 949-493-8020