Healthcare Provider Details

I. General information

NPI: 1275131856
Provider Name (Legal Business Name): ALIGN FOOT AND ANKLE CENTER INC A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E ARRELLAGA ST
SANTA BARBARA CA
93101-2502
US

IV. Provider business mailing address

2460 N PONDEROSA DR STE A105
CAMARILLO CA
93010-2375
US

V. Phone/Fax

Practice location:
  • Phone: 805-965-1515
  • Fax: 805-482-6524
Mailing address:
  • Phone: 805-482-0711
  • Fax: 805-482-6524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HAI-EN PENG
Title or Position: OWNER
Credential: DPM
Phone: 805-482-0711