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General NPI Number Information
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NPI Number | 1750358412
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Entity Type | Organization
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Legal Business Name | ALL CITY PODIATRY CLINIC, INC.
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 610 EUCLID AVE SUITE 304
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2953
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Country | US
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Telephone | 619-470-6800
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Fax | 619-470-2685
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Provider Business Mailing Address
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Address Line | 610 EUCLID AVE SUITE 304
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2953
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Country | US
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Telephone | 619-470-6800
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Fax | 619-470-2685
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA THERESA PANLILIO SANICOLAS
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Credential | D.P.M.
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Telephone | 619-470-6800
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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 | E4303
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License Number State | CA
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