MEDICARE: FOOT SPECIALISTS OF NORTH CONUNTY PODIATRY GROUP,INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E-3486	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295909265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT SPECIALISTS OF NORTH CONUNTY PODIATRY GROUP,INC.

Provider Business Mailing Address
First Line	:	1011 S SANTA FE AVE
Second Line	:	SUITE F
City	:	VISTA
State	:	CA
Zip	:	92083-6917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 S SANTA FE AVE
Second Line	:	SUITE F
City	:	VISTA
State	:	CA
Zip	:	92083-6917
Country	:	US
Telephone Number	:	760-724-5560
Fax Number	:	760-724-6052

Authorized Official
Title or Position	:	PRESIDENT/SECRETARY
Name	:	RONALD VANDERHEYDEN
Credential	:	D.P.M.
Telephone Number	:	760-724-5560

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	04/21/2008

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