MEDICARE: CALIFORNIA FOOT AND ANKLE INSTITUTE, A PODIATRY CORPORATION

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
2	213E00000X	Podiatrist	E1371	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF6858	OTHER	CA	RR MEDICARE GROUP

Other Identifiers

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

General Provider Information

NPI Number	:	1447306964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA FOOT AND ANKLE INSTITUTE, A PODIATRY CORPORATION

Provider Business Mailing Address
First Line	:	20360 SW BIRCH ST STE 100
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1532
Country	:	US
Telephone Number	:	949-833-3406
Fax Number	:	949-833-9955

Provider Business Practice Location Address
First Line	:	20360 SW BIRCH ST STE 100
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1532
Country	:	US
Telephone Number	:	949-833-3406
Fax Number	:	949-833-9955

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL GODDARD
Credential	:	DPM
Telephone Number	:	949-833-3406

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	06/17/2022

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