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General NPI Number Information
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NPI Number | 1902087703
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Entity Type | Organization
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Legal Business Name | LARRY'S COMFORT SHOES & PEDORTHIC SERVICES, INC
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 4801 FOLSOM BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95819-4436
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Country | US
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Telephone | 916-456-7975
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Fax | 916-456-1838
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Provider Business Mailing Address
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Address Line | 4801 FOLSOM BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95819-4436
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Country | US
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Telephone | 916-456-7975
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Fax | 916-456-1838
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Authorized Official
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Title or Position | CERTIFIED PEDORTHIST
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Name | MR. STEVEN J ZUNIGA
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Credential | C. PED
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Telephone | 916-456-7975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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