Basic Information
| Provider Information | |||||||||
| NPI: | 1205342805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH BAY FOOT & ANKLE SPECIALISTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 F ST STE 100 | ||||||||
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| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919102632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194273481 | ||||||||
| FaxNumber: | 6194207807 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 EUCLID AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | NATIONAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919502953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194273481 | ||||||||
| FaxNumber: | 6194207807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2017 | ||||||||
| LastUpdateDate: | 12/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | CHISHOLM | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | ANGUS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6194273481 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.