Provider Demographics
NPI:1972641215
Name:CHRISTIAN FOGLAR , MD, INC.
Entity Type:Organization
Organization Name:CHRISTIAN FOGLAR , MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-224-1267
Mailing Address - Street 1:6140 CAMINO VERDE DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1401
Mailing Address - Country:US
Mailing Address - Phone:408-224-1267
Mailing Address - Fax:408-926-6858
Practice Address - Street 1:6140 CAMINO VERDE DR
Practice Address - Street 2:SUITE L
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1401
Practice Address - Country:US
Practice Address - Phone:408-224-1267
Practice Address - Fax:408-926-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54508207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A545081Medicare UPIN
CA6462650001Medicare NSC