Provider Demographics
NPI:1720350259
Name:FOOTHILL PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:FOOTHILL PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-358-1897
Mailing Address - Street 1:931 BUENA VISTA ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1713
Mailing Address - Country:US
Mailing Address - Phone:626-358-1897
Mailing Address - Fax:626-301-0937
Practice Address - Street 1:931 BUENA VISTA ST STE 205
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1713
Practice Address - Country:US
Practice Address - Phone:626-358-1897
Practice Address - Fax:626-301-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53517208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABG665AMedicare PIN
CAA93232Medicare UPIN
CAFT851ZMedicare PIN