Healthcare Provider Details

I. General information

NPI: 1295899888
Provider Name (Legal Business Name): PODIATRY ASSOCIATES OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 THIRD AVENUE #402
SAN DIEGO CA
92103-5639
US

IV. Provider business mailing address

3330 THIRD AVENUE #402
SAN DIEGO CA
92103-5639
US

V. Phone/Fax

Practice location:
  • Phone: 619-298-1733
  • Fax: 619-294-9604
Mailing address:
  • Phone: 619-298-1733
  • Fax: 619-294-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2237
License Number StateCA

VIII. Authorized Official

Name: MARTIN R TAUBMAN
Title or Position: PRESIDENT/OWNER
Credential: D.P.M.
Phone: 619-298-1733