Provider Demographics
NPI:1528226453
Name:CALIFORNIA FOOT & ANKLE DOCTORS
Entity Type:Organization
Organization Name:CALIFORNIA FOOT & ANKLE DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:F
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:661-874-3668
Mailing Address - Street 1:307 S CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-3650
Mailing Address - Country:US
Mailing Address - Phone:661-874-3668
Mailing Address - Fax:
Practice Address - Street 1:307 S CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-3650
Practice Address - Country:US
Practice Address - Phone:661-874-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2282213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6178150001Medicare NSC