NPIMap

Organization Active NPI

Michael L Wach, DPM, Podiatry Corp

  • Primary Podiatric Medicine Podiatrist
  • Ontario, CA
National Provider Identifier
1568649945
Registry record updated Dec 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X
License
E4125 Issued in CA
Legal business name
MICHAEL L WACH, DPM, PODIATRY CORP
Practice address
1520 N Mountain Ave
BLDG. E 122
Ontario, CA 91762-1128
Phone
(909) 623-4484
Fax
(909) 623-4485
NPI assigned
Jan 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2012

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

Authorized official

Name
Dr. Michael L Wach, D.P.M.
Title
President
Phone
(909) 623-4484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Podiatric Medicine PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213EP1101X E4125 CA Primary

Addresses

Primary practice location

1520 N Mountain Ave
BLDG. E 122
Ontario, CA 91762-1128

Mailing address

1520 N Mountain Ave
BLDG. E 122
Ontario, CA 91762-1128
Phone (909) 623-4484

National Provider Directory

National Provider Directory

Locations

1520 N Mountain Ave
Ste 122
Ontario, CA 91762
Phone (909) 623-4484

NPI Registry JSON

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356480000000",
    "number": "1568649945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 N MOUNTAIN AVE",
            "address_2": "BLDG. E 122",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917621128",
            "telephone_number": "909-623-4484",
            "fax_number": "909-623-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N MOUNTAIN AVE",
            "address_2": "BLDG. E 122",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917621128",
            "telephone_number": "909-623-4484",
            "fax_number": "909-623-4485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL L WACH, DPM, PODIATRY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-28",
        "last_updated": "2012-12-26",
        "status": "A",
        "authorized_official_last_name": "WACH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-623-4484",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CA",
            "license": "E4125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; 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.