Southern California Podiatry Group, Inc.

Key facts

NPI

1699862755

Entity type

Organization (NPI type 2)

Primary specialty

Podiatrist 213E00000X

Legal business name

SOUTHERN CALIFORNIA PODIATRY GROUP, INC.

Practice address

2661 E Florence Ave
Suite B
Huntington Park, CA 90255-4793

Phone

(323) 583-4440

Fax

(323) 583-4499

NPI assigned

Oct 9, 2006

Organization subpart

No

Authorized official

Name

Mr. Jason Wach

Title

Treasurer/Secretary

Phone

(562) 896-5899

National Provider Directory

Specialties & licenses

Addresses

Other names

• DSP Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699862755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6030 VALENCIA ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928803088",
            "telephone_number": "562-896-5899",
            "fax_number": "562-236-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2661 E FLORENCE AVE",
            "address_2": "SUITE B",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554793",
            "telephone_number": "323-583-4440",
            "fax_number": "323-583-4499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PODIATRY GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WACH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "TREASURER/SECRETARY",
        "authorized_official_telephone_number": "562-896-5899",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DSP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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