Provider Demographics
NPI:1598860256
Name:FEDRIGO PODIATRY, APC
Entity Type:Organization
Organization Name:FEDRIGO PODIATRY, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEDRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-331-4500
Mailing Address - Street 1:1125 SIR FRANCIS DRAKE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1418
Mailing Address - Country:US
Mailing Address - Phone:415-461-6555
Mailing Address - Fax:415-461-6556
Practice Address - Street 1:1125 SIR FRANCIS DRAKE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1418
Practice Address - Country:US
Practice Address - Phone:415-461-6555
Practice Address - Fax:415-461-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213ES0103X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric