Provider Demographics
NPI:1437202041
Name:SEQUOIA FOOT CARE GROUP FKA VISALIA-TULARE PODIATRY GROUP
Entity Type:Organization
Organization Name:SEQUOIA FOOT CARE GROUP FKA VISALIA-TULARE PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:559-734-1171
Mailing Address - Street 1:308 S JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6136
Mailing Address - Country:US
Mailing Address - Phone:559-734-1171
Mailing Address - Fax:559-734-6849
Practice Address - Street 1:308 S JOHNSON ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6136
Practice Address - Country:US
Practice Address - Phone:559-734-1171
Practice Address - Fax:559-734-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1210213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0674340001Medicare NSC