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General NPI Number Information
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NPI Number | 1669597274
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Entity Type | Organization
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Legal Business Name | SUTTER PODIATRY GROUP
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 1580 VALENCIA ST SUITE 804
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4412
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Country | US
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Telephone | 415-392-5626
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Fax | 415-392-5632
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Provider Business Mailing Address
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Address Line | 1580 VALENCIA ST SUITE 804
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4412
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Country | US
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Telephone | 415-392-5626
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Fax | 415-392-5632
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Authorized Official
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Title or Position | MANAGER
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Name | REGINA E BENARD
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Credential |
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Telephone | 415-392-5626
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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 | E2434
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License Number State | CA
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