Provider Demographics
NPI:1972690543
Name:FOOT CARE SPECIALISTS, INC A PODIATRY GROUP
Entity Type:Organization
Organization Name:FOOT CARE SPECIALISTS, INC A PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:650-343-7775
Mailing Address - Street 1:39 N SAN MATEO DR
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2832
Mailing Address - Country:US
Mailing Address - Phone:650-343-7775
Mailing Address - Fax:650-343-3954
Practice Address - Street 1:39 N SAN MATEO DR
Practice Address - Street 2:SUITE # 4
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2832
Practice Address - Country:US
Practice Address - Phone:650-343-7775
Practice Address - Fax:650-343-3954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2575213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA902342OtherQME
CAGRE000870Medicaid
CA480020680OtherUMC PROVIDER NUMBER
CA5280028OtherMEDI-CAL PIN
CAE25750OtherPROFESSIONAL LICENCE
CAE25750OtherPROFESSIONAL LICENCE
CAT11383Medicare UPIN
CAE25750OtherPROFESSIONAL LICENCE
CAZZZ20238ZMedicare ID - Type UnspecifiedPODIATRY