Provider Demographics
NPI:1932290178
Name:ASSOCIATED PODIATRY GROUP OF SAN CARLOS
Entity Type:Organization
Organization Name:ASSOCIATED PODIATRY GROUP OF SAN CARLOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEVIANT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:650-593-8083
Mailing Address - Street 1:961 LAUREL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3949
Mailing Address - Country:US
Mailing Address - Phone:650-593-8083
Mailing Address - Fax:650-593-9145
Practice Address - Street 1:961 LAUREL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3949
Practice Address - Country:US
Practice Address - Phone:650-593-8083
Practice Address - Fax:650-593-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3224213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ11218ZOtherMEDICARE GROUP
CA4912900001Medicare NSC
ZZZ11218ZMedicare PIN