| Organization Name: | FOOT FITNESS CENTER PODIATRY GROUP |
| NPI Number: | 1124264833 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD GRENIER (OWNER) |
| Mailing Address: | 4976 Lakeview Ave Yorba Linda |
| State: | CA US |
| Postal Code: | 928864158 |
| Phone Number: | 7147772658 |
| Fax Number: | 7147771055 |
| NPI Enumeration Date: | 12/30/2008 |
| NPI Last Update Date: | 05/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | E2097 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |