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General NPI Number Information
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NPI Number | 1861819476
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Entity Type | Organization
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Legal Business Name | ROGER TSUTSUMI DPM INC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 7111 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-3863
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Country | US
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Telephone | 951-359-8802
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Fax | 951-359-8802
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Provider Business Mailing Address
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Address Line | 7111 MAGNOLIA AVE STE 100
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City | RIVERSIDE
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State | CA
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Zip | 92504-3842
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Country | US
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Telephone | 951-359-8800
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Fax | 951-359-8802
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Authorized Official
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Title or Position | OWNER
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Name | ROGER TSUTSUMI
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Credential | D.P.M.
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Telephone | 951-359-8800
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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 | E4188
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License Number State | CA
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