Provider Demographics
NPI:1518951722
Name:SCIVALLY, JOHN W (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:SCIVALLY
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:130 LA CASA VIA
Mailing Address - Street 2:BLDG. 1, STE. 204
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3045
Mailing Address - Country:US
Mailing Address - Phone:925-937-2860
Mailing Address - Fax:925-937-5565
Practice Address - Street 1:130 LA CASA VIA
Practice Address - Street 2:BLDG. 1, STE. 204
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3045
Practice Address - Country:US
Practice Address - Phone:925-937-2860
Practice Address - Fax:925-937-5565
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2011-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE4319213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E43190Medicaid
CAE83908Medicare UPIN
CAZZZ25716ZMedicare ID - Type Unspecified