Provider Demographics
NPI:1295899888
Name:PODIATRY ASSOCIATES OF SAN DIEGO
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAUBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:619-298-1733
Mailing Address - Street 1:3330 THIRD AVENUE #402
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5639
Mailing Address - Country:US
Mailing Address - Phone:619-298-1733
Mailing Address - Fax:619-294-9604
Practice Address - Street 1:3330 THIRD AVENUE #402
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5639
Practice Address - Country:US
Practice Address - Phone:619-298-1733
Practice Address - Fax:619-294-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2237213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4134698OtherAETNA
CAZZZ07925ZOtherBLUE SHIELD OF CALIF
CAZZZ07925ZOtherBLUE SHIELD OF CALIF