Healthcare Provider Details

I. General information

NPI: 1003121039
Provider Name (Legal Business Name): THOMAS A. CARINE D.P.M. INC. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2010
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 FOREST AVE SUITE 7
SAN JOSE CA
95128-4810
US

IV. Provider business mailing address

2040 FOREST AVE SUITE 7
SAN JOSE CA
95128-4810
US

V. Phone/Fax

Practice location:
  • Phone: 408-287-5751
  • Fax: 408-287-5750
Mailing address:
  • Phone: 408-287-5751
  • Fax: 408-287-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE2090
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS ANTHONY CARINE
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 408-287-5751