Provider Demographics
NPI:1508838251
Name:FUTENMA, CLAIRE EIKO (DPM)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:EIKO
Last Name:FUTENMA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N ALTADENA DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7325
Mailing Address - Country:US
Mailing Address - Phone:626-397-8335
Mailing Address - Fax:626-397-8337
Practice Address - Street 1:55 E CALIFORNIA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3954
Practice Address - Country:US
Practice Address - Phone:626-792-8550
Practice Address - Fax:626-792-3611
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4093A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40930Medicaid
CA000E40931Medicaid
CA4620550001Medicare NSC
CAE4093BMedicare PIN
CAU72826Medicare UPIN
CA000E40930Medicaid