Healthcare Provider Details

I. General information

NPI: 1225004435
Provider Name (Legal Business Name): SPORTS ARENA PODIATRY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 KEMPER ST STE 102
SAN DIEGO CA
92110-4907
US

IV. Provider business mailing address

3340 KEMPER ST STE 102
SAN DIEGO CA
92110-4907
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 Number
License Number State

VIII. Authorized Official

Name: DR. JAMES J FELFOLDI
Title or Position: OWNER
Credential: DPM
Phone: 619-225-9601