Provider Demographics
NPI:1568675007
Name:QOZI, THEODORE BASILE (DPM)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:BASILE
Last Name:QOZI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 TOWN GARDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-3072
Mailing Address - Country:US
Mailing Address - Phone:760-583-3006
Mailing Address - Fax:
Practice Address - Street 1:2617 TOWN GARDEN ROAD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-3072
Practice Address - Country:US
Practice Address - Phone:760-583-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4720213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery