Provider Demographics
NPI:1609041797
Name:DAVIS PODIATRY CENTER, INC.
Entity Type:Organization
Organization Name:DAVIS PODIATRY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:C
Authorized Official - Last Name:FERRAGAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:530-753-9080
Mailing Address - Street 1:2925 SPAFFORD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6808
Mailing Address - Country:US
Mailing Address - Phone:530-753-9080
Mailing Address - Fax:530-753-9085
Practice Address - Street 1:2925 SPAFFORD ST
Practice Address - Street 2:SUITE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6808
Practice Address - Country:US
Practice Address - Phone:530-753-9080
Practice Address - Fax:530-753-9085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE37620261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6229190001Medicare NSC
CA000E37620Medicare PIN
CAU23783Medicare UPIN