Provider Demographics
NPI:1508338054
Name:INTEGRATIVE FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:INTEGRATIVE FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:MINA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:707-241-4116
Mailing Address - Street 1:600 NUT TREE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4656
Mailing Address - Country:US
Mailing Address - Phone:707-241-4116
Mailing Address - Fax:
Practice Address - Street 1:600 NUT TREE RD STE 210
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-241-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty