Provider Demographics
NPI:1558051755
Name:SOCAL FOOT CARE PC
Entity Type:Organization
Organization Name:SOCAL FOOT CARE PC
Other - Org Name:SOCAL FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-436-8667
Mailing Address - Street 1:9850 GENESEE AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1213
Mailing Address - Country:US
Mailing Address - Phone:858-450-9218
Mailing Address - Fax:858-450-3296
Practice Address - Street 1:501 N EL CAMINO REAL STE 201
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1335
Practice Address - Country:US
Practice Address - Phone:760-436-8667
Practice Address - Fax:760-436-2292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCAL FOOT CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-10
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty