Provider Demographics
NPI:1558833285
Name:PACIFIC POINT PODIATRY, INC
Entity Type:Organization
Organization Name:PACIFIC POINT PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:831-708-1110
Mailing Address - Street 1:9500 SOQUEL DR STE A
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4158
Mailing Address - Country:US
Mailing Address - Phone:831-288-3400
Mailing Address - Fax:831-288-3405
Practice Address - Street 1:9500 SOQUEL DR STE A
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4158
Practice Address - Country:US
Practice Address - Phone:831-288-3400
Practice Address - Fax:831-288-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty