Provider Demographics
NPI:1083336705
Name:ONTARIO FOOT DOCTOR & WOUND CARE
Entity Type:Organization
Organization Name:ONTARIO FOOT DOCTOR & WOUND CARE
Other - Org Name:ONTARIO FOOT DOCTOR & WOUND CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:NORRIS
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:951-479-2915
Mailing Address - Street 1:7426 CHERRY AVE STE 210-123
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4221
Mailing Address - Country:US
Mailing Address - Phone:909-983-5710
Mailing Address - Fax:
Practice Address - Street 1:7426 CHERRY AVE STE 210-123
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4221
Practice Address - Country:US
Practice Address - Phone:909-983-5710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty