Provider Demographics
NPI:1851569206
Name:WILLIAM J KALANTA D.P.M.
Entity Type:Organization
Organization Name:WILLIAM J KALANTA D.P.M.
Other - Org Name:CERES FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:KALANTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:209-538-1731
Mailing Address - Street 1:1941 MITCHELL RD
Mailing Address - Street 2:STE - R
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2434
Mailing Address - Country:US
Mailing Address - Phone:209-538-1731
Mailing Address - Fax:209-581-0540
Practice Address - Street 1:1941 MITCHELL RD
Practice Address - Street 2:STE - R
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2434
Practice Address - Country:US
Practice Address - Phone:209-538-1731
Practice Address - Fax:209-581-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE21361213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE21361Medicaid
CA5106520001Medicare NSC
CA000E21361Medicare PIN
CAT11194Medicare UPIN