Provider Demographics
NPI:1396002887
Name:CENTRAL VALLEY FOOT AND ANKLE INC
Entity Type:Organization
Organization Name:CENTRAL VALLEY FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:559-636-3668
Mailing Address - Street 1:128 N AKERS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5121
Mailing Address - Country:US
Mailing Address - Phone:559-636-3668
Mailing Address - Fax:559-636-3665
Practice Address - Street 1:1011 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4101
Practice Address - Country:US
Practice Address - Phone:559-636-3668
Practice Address - Fax:559-636-3665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VALLEY FOOT AND ANKLE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4211213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFV102AMedicare UPIN