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General NPI Number Information
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NPI Number | 1740009836
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Entity Type | Organization
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Legal Business Name | WELLNESS PODIATRY CORP
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 5025 J ST STE 316
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City | SACRAMENTO
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State | CA
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Zip | 95819-3839
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Country | US
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Telephone | 916-732-2277
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Fax | 916-786-6770
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Provider Business Mailing Address
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Address Line | 685 TWELVE BRIDGES DR STE F
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City | LINCOLN
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State | CA
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Zip | 95648-8689
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Country | US
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Telephone | 916-786-3434
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN VAN PHAM
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Credential | DPM
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Telephone | 916-408-5580
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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 |
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License Number State |
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