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General NPI Number Information
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NPI Number | 1184650921
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Entity Type | Organization
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Legal Business Name | DISORDERS OF THE FOOT AND ANKLE
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 331 SEA RIDGE DRIVE
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City | LA JOLLA
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State | CA
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Zip | 92037
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Country | US
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Telephone | 858-488-4008
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Fax | 877-297-2958
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Provider Business Mailing Address
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Address Line | 5580 LA JOLLA BLVD #55
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City | LA JOLLA
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State | CA
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Zip | 92037
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Country | US
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Telephone | 858-488-4008
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Fax | 877-297-2958
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Authorized Official
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Title or Position | CEO
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Name | SHARON MARIE DREEBEN
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Credential | MD
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Telephone | 858-488-4008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | G67534
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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