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General NPI Number Information
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NPI Number | 1639355381
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Entity Type | Organization
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Legal Business Name | JOHN W. SCIVALLY, D.P.M INC
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 2227 OLYMPIC BLVD
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City | WALNUT CREEK
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State | CA
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Zip | 94595-1623
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Country | US
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Telephone | 925-937-2860
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Fax | 925-937-5565
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Provider Business Mailing Address
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Address Line | 2227 OLYMPIC BLVD
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City | WALNUT CREEK
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State | CA
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Zip | 94595-1623
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Country | US
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Telephone | 925-937-2860
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Fax | 925-937-5565
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Authorized Official
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Title or Position | OWNER/ PHYSICIAN
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Name | MR. JOHN W SCIVALLY
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Credential | D.P.M
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Telephone | 925-937-2860
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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 | E4319
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License Number State | CA
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