Provider Demographics
NPI:1790968618
Name:FEDRIGO PODIATRY A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FEDRIGO PODIATRY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEDRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-461-6555
Mailing Address - Street 1:599 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1712
Mailing Address - Country:US
Mailing Address - Phone:415-461-6555
Mailing Address - Fax:415-461-6556
Practice Address - Street 1:599 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1712
Practice Address - Country:US
Practice Address - Phone:415-461-6555
Practice Address - Fax:415-461-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4298261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E42980OtherMEDICARE