Provider Demographics
NPI:1104985886
Name:NORTH PENINSULA PODIATRY GROUP, INC.
Entity type:Organization
Organization Name:NORTH PENINSULA PODIATRY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFC. COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENESES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:650-588-9189
Mailing Address - Street 1:560 JENEVEIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066
Mailing Address - Country:US
Mailing Address - Phone:650-588-9189
Mailing Address - Fax:650-588-2814
Practice Address - Street 1:560 JENEVEIN AVENUE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:650-588-9189
Practice Address - Fax:650-588-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3983213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU61109Medicare UPIN
CAU83639Medicare UPIN
CAT11769Medicare UPIN