Provider Demographics
NPI:1821751736
Name:CUPERTINO PODIATRY INC.
Entity Type:Organization
Organization Name:CUPERTINO PODIATRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MANNINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-489-3414
Mailing Address - Street 1:15100 LOS GATOS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2028
Mailing Address - Country:US
Mailing Address - Phone:408-358-6234
Mailing Address - Fax:408-358-6234
Practice Address - Street 1:15100 LOS GATOS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2028
Practice Address - Country:US
Practice Address - Phone:408-358-6234
Practice Address - Fax:408-358-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty