=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932613759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKVIEW PODIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2017
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 PARK ST
-----------------------------------------------------
City | LAKEPORT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95453-4803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-263-9595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 PARK ST
-----------------------------------------------------
City | LAKEPORT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95453-4803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-263-9595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | TONIA SILVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-349-3509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | E4707
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | E4707
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------