Provider Demographics
NPI:1295249902
Name:SAN DIEGO FOOT & ANKLE, INC
Entity type:Organization
Organization Name:SAN DIEGO FOOT & ANKLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:619-291-0777
Mailing Address - Street 1:2650 CAMINO DEL RIO N STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1630
Mailing Address - Country:US
Mailing Address - Phone:619-291-0777
Mailing Address - Fax:619-291-3231
Practice Address - Street 1:2650 CAMINO DEL RIO N STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1630
Practice Address - Country:US
Practice Address - Phone:619-291-0777
Practice Address - Fax:619-291-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty