Healthcare Provider Details

I. General information

NPI: 1093986887
Provider Name (Legal Business Name): STEVEN I. SUBOTNICK, DPM,MS A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13690 E 14TH ST SUITE 220
SAN LEANDRO CA
94578-2582
US

IV. Provider business mailing address

13690 E 14TH ST SUITE 220
SAN LEANDRO CA
94578-2582
US

V. Phone/Fax

Practice location:
  • Phone: 510-614-5633
  • Fax: 510-614-2286
Mailing address:
  • Phone: 510-614-5633
  • Fax: 510-614-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE1340
License Number StateCA

VIII. Authorized Official

Name: JANICE SUBOTNICK
Title or Position: OFFICE MANAGER
Credential:
Phone: 510-614-5633