Provider Demographics
NPI:1558130369
Name:ELK GROVE FOOT AND ANKLE PC
Entity Type:Organization
Organization Name:ELK GROVE FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-980-9611
Mailing Address - Street 1:5501 CASTLEFORD WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4766
Mailing Address - Country:US
Mailing Address - Phone:505-980-9611
Mailing Address - Fax:
Practice Address - Street 1:5501 CASTLEFORD WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4766
Practice Address - Country:US
Practice Address - Phone:505-980-9611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty