Basic Information
| Provider Information | |||||||||
| NPI: | 1063498749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAGSOLINGAN | ||||||||
| FirstName: | JUAN RODERICK | ||||||||
| MiddleName: | BALZA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | KING CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939303432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313855471 | ||||||||
| FaxNumber: | 8313855940 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | KING CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939303432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313855471 | ||||||||
| FaxNumber: | 8313855940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 11/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | E4169 | CA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | E4169 | CA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00E416900 | 05 | CA | MEDICAID |