Healthcare Provider Details

I. General information

NPI: 1346482445
Provider Name (Legal Business Name): JOSEPH ANTHONY AVERNA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 - 5TH AVE STE 106
SAN DIEGO CA
92103
US

IV. Provider business mailing address

3500 - 5TH AVE STE 106
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-8449
  • Fax: 619-294-2844
Mailing address:
  • Phone: 619-294-8449
  • Fax: 619-294-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE1275
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE1275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: