Provider Demographics
NPI:1326034083
Name:SCATENA, MICHAEL N (DPM)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:N
Last Name:SCATENA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3031 W MARCH LN
Mailing Address - Street 2:#203
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-6500
Mailing Address - Country:US
Mailing Address - Phone:209-956-2847
Mailing Address - Fax:209-956-3514
Practice Address - Street 1:3031 W MARCH LN
Practice Address - Street 2:#203
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6500
Practice Address - Country:US
Practice Address - Phone:209-956-2847
Practice Address - Fax:209-956-3514
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4575213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E45750Medicaid
CA000E45750Medicaid
000E45750Medicare ID - Type Unspecified