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General NPI Number Information
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NPI Number | 1396095881
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Entity Type | Organization
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Legal Business Name | LAKE TAHOE PODIATRY A PROFESSIONAL PODIATRIC CORPORATION
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 2229 BARTON AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-3411
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Country | US
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Telephone | 530-541-2665
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Fax | 530-541-2615
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Provider Business Mailing Address
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Address Line | 2229 BARTON AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-3411
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Country | US
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Telephone | 530-541-2665
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Fax | 530-541-2615
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICIA L FERRARO
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Credential | D.P.M.
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Telephone | 530-541-2665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E3664
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License Number State | CA
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