Provider Demographics
NPI:1871600239
Name:MATARANGAS, SANDI ELLEDGE (DPM)
Entity type:Individual
Prefix:DR
First Name:SANDI
Middle Name:ELLEDGE
Last Name:MATARANGAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:227 N JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1603
Mailing Address - Country:US
Mailing Address - Phone:408-871-3200
Mailing Address - Fax:408-871-5217
Practice Address - Street 1:227 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1603
Practice Address - Country:US
Practice Address - Phone:408-871-3400
Practice Address - Fax:408-871-5217
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4328213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89250Medicare UPIN