Provider Demographics
NPI:1609613785
Name:SPENCER RODRIGUEZ PODIATRY CORPORATION
Entity type:Organization
Organization Name:SPENCER RODRIGUEZ PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-364-9255
Mailing Address - Street 1:333 CORPORATE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2180
Mailing Address - Country:US
Mailing Address - Phone:949-364-9255
Mailing Address - Fax:
Practice Address - Street 1:2617 E CHAPMAN AVE STE 303
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3256
Practice Address - Country:US
Practice Address - Phone:714-639-7993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty