Podiatry Group South a Proffessional Podiatry Corporation

Primary specialty

Public Medicine PodiatristTaxonomy code 213EP0504X

License

E2340 Issued in CA

Legal business name

PODIATRY GROUP SOUTH A PROFFESSIONAL PODIATRY CORPORATION

Practice address

425 W Bonita Ave Ste 110
San Dimas, CA 91773-2543

Phone

(909) 599-0981

Fax

(909) 592-0738

NPI assigned

Jan 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ira A Diamond, DPM

Title

Sole Owner

Phone

(909) 599-0981

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394496000000",
    "number": "1548314396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W BONITA AVE STE 110",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732543",
            "telephone_number": "909-599-0981",
            "fax_number": "909-592-0738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W BONITA AVE STE 110",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732543",
            "telephone_number": "909-599-0981",
            "fax_number": "909-592-0738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODIATRY GROUP SOUTH A PROFFESSIONAL PODIATRY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2014-03-11",
        "status": "A",
        "authorized_official_last_name": "DIAMOND",
        "authorized_official_first_name": "IRA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "909-599-0981",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP0504X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Public Medicine",
            "state": "CA",
            "license": "E2340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRE000821",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.