Healthcare Provider Details

I. General information

NPI: 1922518653
Provider Name (Legal Business Name): IHA PODIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 MISSION CENTER COURT SUITE 250
SAN DIEGO CA
92108
US

IV. Provider business mailing address

7801 MISSION CENTER COURT SUITE 250
SAN DIEGO CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 619-738-5566
  • Fax: 619-566-0202
Mailing address:
  • Phone: 619-738-5566
  • Fax: 619-566-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: KAREN KANAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 619-738-5566