Healthcare Provider Details

I. General information

NPI: 1174675508
Provider Name (Legal Business Name): SILICON VALLEY PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 SAMARITAN DR STE 509
SAN JOSE CA
95124-4015
US

IV. Provider business mailing address

2505 SAMARITAN DR STE 509
SAN JOSE CA
95124-4015
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-2666
  • Fax: 408-358-7974
Mailing address:
  • Phone: 408-358-2666
  • Fax: 408-358-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1333
License Number StateCA

VIII. Authorized Official

Name: MARIA HERNANDEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 408-358-2666