Provider Demographics
NPI:1831770189
Name:DIABLO PODIATRY
Entity type:Organization
Organization Name:DIABLO PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-818-6450
Mailing Address - Street 1:2301 CAMINO RAMON STE 290
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2060
Mailing Address - Country:US
Mailing Address - Phone:925-831-1898
Mailing Address - Fax:
Practice Address - Street 1:2301 CAMINO RAMON STE 290
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2060
Practice Address - Country:US
Practice Address - Phone:925-831-1898
Practice Address - Fax:925-831-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty