Provider Demographics
NPI:1417117698
Name:SAN GABRIEL VALLEY FOOT AND ANKLE CLINIC, INC.
Entity Type:Organization
Organization Name:SAN GABRIEL VALLEY FOOT AND ANKLE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:ZORRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-282-3157
Mailing Address - Street 1:323 W LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1212
Mailing Address - Country:US
Mailing Address - Phone:626-282-3157
Mailing Address - Fax:626-282-3727
Practice Address - Street 1:323 W LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1212
Practice Address - Country:US
Practice Address - Phone:626-282-3157
Practice Address - Fax:626-282-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3449332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1179690001Medicare NSC