Provider Demographics
NPI:1912528928
Name:CLEMENT PODIATRY PC
Entity Type:Organization
Organization Name:CLEMENT PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTOVER-KERMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-898-4828
Mailing Address - Street 1:1615 HILL RD STE E
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4338
Mailing Address - Country:US
Mailing Address - Phone:415-898-4828
Mailing Address - Fax:415-898-4878
Practice Address - Street 1:1615 HILL RD STE E
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4338
Practice Address - Country:US
Practice Address - Phone:415-898-4828
Practice Address - Fax:415-898-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty