Provider Demographics
NPI:1184097081
Name:FOOT DOCTORS OF SANTA CRUZ COUNTY, INC. A PODIATRY GROUP
Entity type:Organization
Organization Name:FOOT DOCTORS OF SANTA CRUZ COUNTY, INC. A PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGE
Authorized Official - Prefix:
Authorized Official - First Name:RUBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-359-3943
Mailing Address - Street 1:47 PENNY LN STE 1
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6055
Mailing Address - Country:US
Mailing Address - Phone:931-728-8844
Mailing Address - Fax:831-763-1001
Practice Address - Street 1:243 MOUNT HERMON RD STE G
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4085
Practice Address - Country:US
Practice Address - Phone:831-438-3668
Practice Address - Fax:831-438-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty