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General NPI Number Information
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NPI Number | 1568772820
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Entity Type | Organization
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Legal Business Name | FAIRMOUNT PODIATRY GROUP
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 7524 FAIRMOUNT AVE
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City | EL CERRITO
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State | CA
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Zip | 94530-3746
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Country | US
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Telephone | 510-526-4244
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Fax | 510-526-9251
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Provider Business Mailing Address
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Address Line | 7524 FAIRMOUNT AVE
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City | EL CERRITO
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State | CA
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Zip | 94530-3746
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Country | US
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Telephone | 510-526-4244
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Fax | 510-526-9251
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. DARLENE JO FAHMIE
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Credential | D.P.M.
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Telephone | 510-526-4266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | E3401
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License Number State | CA
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