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General NPI Number Information
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NPI Number | 1265730493
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Entity Type | Organization
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Legal Business Name | PACIFIC PODIATRY CONSULTANTS INC
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 6244 EL CAJON BLVD SUITE 29
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City | SAN DIEGO
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State | CA
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Zip | 92115-3918
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Country | US
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Telephone | 619-287-4740
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Fax | 619-287-4741
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Provider Business Mailing Address
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Address Line | 6244 EL CAJON BLVD SUITE 29
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City | SAN DIEGO
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State | CA
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Zip | 92115-3918
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Country | US
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Telephone | 619-287-4740
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Fax | 619-287-4741
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Authorized Official
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Title or Position | OWNER
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Name | HAI T TRAN
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Credential | DPM
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Telephone | 619-287-4740
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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 | E4624
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License Number State | CA
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