Basic Information
| Provider Information | |||||||||
| NPI: | 1922518653 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IHA PODIATRY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7801 MISSION CENTER COURT | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197385566 | ||||||||
| FaxNumber: | 6195660202 | ||||||||
| Practice Location | |||||||||
| Address1: | 7801 MISSION CENTER COURT | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197385566 | ||||||||
| FaxNumber: | 6195660202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2017 | ||||||||
| LastUpdateDate: | 10/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | KANAN | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6197385566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.