GERIATRIC PODIATRY MEDICAL GROUP INC. NPI 1598832172

NPI Information

NPI: 1598832172
Provider Name: GERIATRIC PODIATRY MEDICAL GROUP INC.
Classification: Podiatrist - 213EP0504X
Entity Type: Organization

Specialization: Public Medicine

Address:
425 W BONITA AVE STE 110
SAN DIMAS, CA
ZIP 91773
Phone: (909) 599-0981
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GERIATRIC PODIATRY MEDICAL GROUP INC. is a public medicine podiatrist in San Dimas, CA. GERIATRIC PODIATRY MEDICAL GROUP INC. NPI is 1598832172. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

425 W BONITA AVE STE 110
SAN DIMAS, CA
ZIP 91773-543
Phone: (909) 599-0981
Fax: (909) 592-0738

The provider's authorized official is William H Tabb .
The authorized official title is Owner and has the following contact phone number (909) 599-0981.

The enumeration date for this NPI number is 11/29/2006 and was last updated on 12/16/2014.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213EP0504X	Podiatrist	Public Medicine			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	T11349	MEDICARE UPIN	CALIFORNIA
2	000E24782	MEDICARE PIN	CALIFORNIA
3	GRE000052	MEDICAID	CALIFORNIA
4	WE2478D	MEDICARE PIN	CALIFORNIA
5	480032496	MEDICARE PIN	CALIFORNIA
6	GRE000050	MEDICAID	CALIFORNIA
7	ZZZ13603Z	MEDICARE PIN	CALIFORNIA
8	W15303	MEDICARE PIN	CALIFORNIA
9	CJ3207	OTHER	CALIFORNIA	PALMETTO GBA

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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