Provider Demographics
NPI:1629028923
Name:GARFOLO, CRAIG STEVEN (DPM)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:STEVEN
Last Name:GARFOLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1350 W ROBINHOOD DRIVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-473-1011
Mailing Address - Fax:209-473-4317
Practice Address - Street 1:1350 W ROBINHOOD DR
Practice Address - Street 2:SUITE 14
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5512
Practice Address - Country:US
Practice Address - Phone:209-473-1011
Practice Address - Fax:209-473-4317
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3309213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E33090Medicaid
CA000E33090Medicaid
CA000E33090Medicare ID - Type Unspecified
CA1085530001Medicare NSC