Provider Demographics
NPI:1689067266
Name:SOCAL PODIATRY, P.C.
Entity Type:Organization
Organization Name:SOCAL PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BOYKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-734-0713
Mailing Address - Street 1:PO BOX 1321
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92556-1321
Mailing Address - Country:US
Mailing Address - Phone:954-734-0713
Mailing Address - Fax:
Practice Address - Street 1:11411 BROOKSHIRE AVE STE 501
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5007
Practice Address - Country:US
Practice Address - Phone:562-651-1050
Practice Address - Fax:562-868-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5157213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty