Provider Demographics
NPI:1639234446
Name:PODIATRY ASSOCIATES OF SAN DIEGO COUNTY, INC.
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF SAN DIEGO COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAUBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:619-298-1733
Mailing Address - Street 1:3330 3RD AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5639
Mailing Address - Country:US
Mailing Address - Phone:619-298-1733
Mailing Address - Fax:619-294-9604
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-472-0252
Practice Address - Fax:619-294-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2237213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15787AMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER