Basic Information
| Provider Information | |||||||||
| NPI: | 1710196530 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PODIATRY CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31441 SANTA MARGARITA PKWY | ||||||||
| Address2: | A-258 | ||||||||
| City: | RANCHO SANTA MARGARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926881836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496319009 | ||||||||
| FaxNumber: | 9496311984 | ||||||||
| Practice Location | |||||||||
| Address1: | 2216 NEWPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926271711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496319009 | ||||||||
| FaxNumber: | 9496311984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 09/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | TOBIAS | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9496319009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | E1594 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.