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PACIFIC COAST PODIATRY PC NPI 1285080978


NPI Information

NPI: 1285080978
Provider Name: PACIFIC COAST PODIATRY PC
Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization
Address:
1762 N WATERMAN AVE
SAN BERNARDINO, CA
ZIP 92404
Phone: (909) 886-3668
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PACIFIC COAST PODIATRY PC is a preferred provider organization in San Bernardino, CA. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. PACIFIC COAST PODIATRY PC NPI is 1285080978. The provider is registered as an organization entity type.

The provider's business location address is:

1762 N WATERMAN AVE
SAN BERNARDINO, CA
ZIP 92404-130
Phone: (909) 886-3668
Fax: (909) 886-5542

The provider's authorized official is Clayton Gary Johnsen .
The authorized official title is Owner and has the following contact phone number (909) 886-3668.

The enumeration date for this NPI number is 5/11/2016 and was last updated on 6/20/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1305R00000XPreferred Provider OrganizationE4834CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11285080978OTHERNPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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