Healthcare Provider Details

I. General information

NPI: 1639355381
Provider Name (Legal Business Name): JOHN W. SCIVALLY, D.P.M INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 OLYMPIC BLVD
WALNUT CREEK CA
94595-1623
US

IV. Provider business mailing address

2227 OLYMPIC BLVD
WALNUT CREEK CA
94595-1623
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-2860
  • Fax: 925-937-5565
Mailing address:
  • Phone: 925-937-2860
  • Fax: 925-937-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4319
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN W SCIVALLY
Title or Position: OWNER/ PHYSICIAN
Credential: D.P.M
Phone: 925-937-2860