Healthcare Provider Details

I. General information

NPI: 1508273368
Provider Name (Legal Business Name): PHILIP B. SANFILIPPO II, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 OCEAN AVE SUITE 205
SAN FRANCISCO CA
94132-1645
US

IV. Provider business mailing address

2555 OCEAN AVE SUITE 205
SAN FRANCISCO CA
94132-1645
US

V. Phone/Fax

Practice location:
  • Phone: 650-245-2235
  • Fax: 949-862-7639
Mailing address:
  • Phone: 650-245-2235
  • Fax: 949-862-7639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE3614
License Number StateCA

VIII. Authorized Official

Name: PHILIP B. SANFILIPPO
Title or Position: OWNER
Credential: D.P.M.
Phone: 650-245-2235