Healthcare Provider Details

I. General information

NPI: 1902340201
Provider Name (Legal Business Name): SAN MATEO FOOT AND ANKLE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S SAN MATEO DR STE 212
SAN MATEO CA
94401-3843
US

IV. Provider business mailing address

101 S SAN MATEO DR STE 212
SAN MATEO CA
94401-3843
US

V. Phone/Fax

Practice location:
  • Phone: 650-342-5733
  • Fax: 650-342-0525
Mailing address:
  • Phone: 650-342-5733
  • Fax: 650-342-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE3347
License Number StateCA

VIII. Authorized Official

Name: DR. KENNETH JOSEPH PASSERI
Title or Position: PRESIDANT
Credential: D.P.M.
Phone: 650-342-5733