Provider Demographics
NPI:1639354004
Name:PACIFIC FOOT & ANKLE SPECIALISTS, INC.
Entity Type:Organization
Organization Name:PACIFIC FOOT & ANKLE SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-542-0656
Mailing Address - Street 1:1125 E 17TH ST
Mailing Address - Street 2:SUITE E-107
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2201
Mailing Address - Country:US
Mailing Address - Phone:714-542-0656
Mailing Address - Fax:714-542-5059
Practice Address - Street 1:1125 E 17TH ST
Practice Address - Street 2:SUITE E-107
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2201
Practice Address - Country:US
Practice Address - Phone:714-542-0656
Practice Address - Fax:714-542-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier