Provider Demographics
NPI:1447306964
Name:CALIFORNIA FOOT AND ANKLE INSTITUTE, A PODIATRY CORPORATION
Entity type:Organization
Organization Name:CALIFORNIA FOOT AND ANKLE INSTITUTE, A PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-833-3406
Mailing Address - Street 1:20360 SW BIRCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1532
Mailing Address - Country:US
Mailing Address - Phone:949-833-3406
Mailing Address - Fax:949-833-9955
Practice Address - Street 1:20360 SW BIRCH ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1532
Practice Address - Country:US
Practice Address - Phone:949-833-3406
Practice Address - Fax:949-833-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1371213E00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF6858OtherRR MEDICARE GROUP
CAGRE000060Medicaid
CAGRE000060Medicaid
CAZZZ04379ZMedicare PIN
CADF6858OtherRR MEDICARE GROUP