Healthcare Provider Details

I. General information

NPI: 1508338054
Provider Name (Legal Business Name): INTEGRATIVE FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NUT TREE RD STE 210
VACAVILLE CA
95687
US

IV. Provider business mailing address

600 NUT TREE RD STE 210
VACAVILLE CA
95687-4656
US

V. Phone/Fax

Practice location:
  • Phone: 707-241-4116
  • Fax:
Mailing address:
  • Phone: 707-241-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH LOIS MINA
Title or Position: OWNER/DOCTOR
Credential: DPM
Phone: 707-241-4116