NPIMap

Organization Active NPI

Michael K Fairbanks DPM a Professional Corporation

  • Podiatrist
  • San Dimas, CA
National Provider Identifier
1629358411
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E2726 Issued in CA
Legal business name
MICHAEL K FAIRBANKS DPM A PROFESSIONAL CORPORATION
Practice address
425 W Bonita Ave
Suite 110
San Dimas, CA 91773-2541
Phone
(909) 599-0981
Fax
(909) 592-0738
NPI assigned
Aug 24, 2011
Last updated
Nov 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

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

Authorized official

Name
Michael K Fairbanks, DPMNPI 1578678926
Title
Sole Owner
Phone
(619) 465-4972

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X E2726 CA Primary

Addresses

Primary practice location

425 W Bonita Ave
Suite 110
San Dimas, CA 91773-2541

Mailing address

7750 Eastridge Dr
La Mesa, CA 91941-7882
Phone (619) 465-4972

National Provider Directory

National Provider Directory

Locations

1201 S Orange Ave
El Cajon, CA 92020
Phone (619) 441-1988

7922 Palm St
Lemon Grove, CA 91945
Phone (619) 464-3488

3022 45th St
San Diego, CA 92105
Phone (619) 283-5855

8060 Frost St
San Diego, CA 92123
Phone (858) 275-4750

8625 Lamar St
Spring Valley, CA 91977
Phone (619) 461-3222

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478649600000",
    "number": "1629358411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7750 EASTRIDGE DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919417882",
            "telephone_number": "619-465-4972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W BONITA AVE",
            "address_2": "SUITE 110",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732541",
            "telephone_number": "909-599-0981",
            "fax_number": "909-592-0738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL K FAIRBANKS DPM A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-24",
        "last_updated": "2016-11-09",
        "status": "A",
        "authorized_official_last_name": "FAIRBANKS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "619-465-4972",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E2726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; 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.