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General NPI Number Information
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NPI Number | 1851109318
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Entity Type | Organization
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Legal Business Name | WAVES FOOT AND ANKLE INC.
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 821 E CHAPEL ST STE 101
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City | SANTA MARIA
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State | CA
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Zip | 93454-4618
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Country | US
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Telephone | 805-925-8703
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Fax | 805-349-8315
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Provider Business Mailing Address
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Address Line | 821 E CHAPEL ST STE 101
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City | SANTA MARIA
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State | CA
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Zip | 93454-4618
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Country | US
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Telephone | 805-925-8703
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Fax | 805-349-8315
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Authorized Official
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Title or Position | CEO
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Name | BRANDON SLADE
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Credential | DPM
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Telephone | 805-925-8703
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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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