Provider Demographics
NPI:1467621227
Name:MCC CADIEUX LLC
Entity Type:Organization
Organization Name:MCC CADIEUX LLC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE JO
Authorized Official - Middle Name:
Authorized Official - Last Name:CADIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:951-506-6325
Mailing Address - Street 1:29700 RANCHO CALIFORNIA RD
Mailing Address - Street 2:STE G7
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5205
Mailing Address - Country:US
Mailing Address - Phone:951-506-6325
Mailing Address - Fax:951-506-6382
Practice Address - Street 1:29700 RANCHO CALIFORNIA RD
Practice Address - Street 2:STE G7
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5205
Practice Address - Country:US
Practice Address - Phone:951-506-6325
Practice Address - Fax:951-506-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5149860001Medicare NSC