Provider Demographics
NPI:1598891871
Name:SADDLEBACK VALLEY PODIATRY GROUP INC.
Entity Type:Organization
Organization Name:SADDLEBACK VALLEY PODIATRY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SABET
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-768-9495
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA
Mailing Address - Street 2:STE 143
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3616
Mailing Address - Country:US
Mailing Address - Phone:949-768-9495
Mailing Address - Fax:949-768-8018
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:STE 143
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-768-9495
Practice Address - Fax:949-768-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2627213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE000020Medicaid
CAZZZ87084ZOtherBLUE SHIELD
CAWE7359Medicare UPIN
CAGRE000020Medicaid
0346220001Medicare NSC