Provider Demographics
NPI:1619396884
Name:SPENCER RODRIGUEZ PODIATRY CORPORATION
Entity Type:Organization
Organization Name:SPENCER RODRIGUEZ PODIATRY CORPORATION
Other - Org Name:SOUTHERN CALIFORNIA FOOT AND ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-488-0666
Mailing Address - Street 1:333 CORPORATE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2180
Mailing Address - Country:US
Mailing Address - Phone:949-364-9255
Mailing Address - Fax:949-364-9250
Practice Address - Street 1:333 CORPORATE DR STE 230
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2180
Practice Address - Country:US
Practice Address - Phone:949-364-9255
Practice Address - Fax:949-364-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4828213ES0103X
CAE4790213ES0103X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty