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General NPI Number Information
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NPI Number | 1033284591
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Entity Type | Organization
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Legal Business Name | NORTH BAY FOOT AND ANKLE CLINIC, INC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 1041 4TH ST SUITE B
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City | SANTA ROSA
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State | CA
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Zip | 95404-4329
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Country | US
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Telephone | 707-546-2107
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Fax | 707-573-0315
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Provider Business Mailing Address
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Address Line | 1041 4TH ST SUITE B
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City | SANTA ROSA
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State | CA
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Zip | 95404-4329
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Country | US
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Telephone | 707-546-2107
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Fax | 707-573-0315
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Authorized Official
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Title or Position | CEO
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Name | DR. ADELINA B STATEVA
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Credential | DPM
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Telephone | 707-546-2107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4562
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License Number State | CA
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