Provider Demographics
NPI:1447351580
Name:ADDES, SHIRLEY ANN (DPM)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:ADDES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3746
Mailing Address - Country:US
Mailing Address - Phone:510-526-4244
Mailing Address - Fax:510-526-9251
Practice Address - Street 1:7524 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3746
Practice Address - Country:US
Practice Address - Phone:510-526-4244
Practice Address - Fax:510-526-9251
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3411213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1231119Medicaid
CA1231119Medicaid
CAT11682Medicare UPIN