Provider Demographics
NPI:1417135955
Name:JAMES A. DE SILVA, DPM, INC.
Entity Type:Organization
Organization Name:JAMES A. DE SILVA, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:DE SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:951-737-1102
Mailing Address - Street 1:817 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3406
Mailing Address - Country:US
Mailing Address - Phone:951-737-1102
Mailing Address - Fax:951-737-5150
Practice Address - Street 1:817 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3406
Practice Address - Country:US
Practice Address - Phone:951-737-1102
Practice Address - Fax:951-737-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2121213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11181Medicare UPIN
CA000E21210Medicare PIN
CA0705200001Medicare NSC