Healthcare Provider Details

I. General information

NPI: 1225915994
Provider Name (Legal Business Name): SAN DIEGO MOBILE PODIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16870 W BERNARDO DR STE 202
SAN DIEGO CA
92127-1671
US

IV. Provider business mailing address

16870 W BERNARDO DR STE 202
SAN DIEGO CA
92127-1671
US

V. Phone/Fax

Practice location:
  • Phone: 650-793-6287
  • Fax:
Mailing address:
  • Phone: 650-793-6287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. TYSON SCHMIDTHUBER
Title or Position: AUTHORIZED OFFICIAL
Credential: DPM
Phone: 650-793-6287