| Organization Name: | PACIFIC COAST PODIATRY |
| NPI Number: | 1285080978 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CLAYTON GARY JOHNSEN (OWNER) |
| Mailing Address: | 1762 N Waterman Ave San Bernardino |
| State: | CA US |
| Postal Code: | 924045130 |
| Phone Number: | 9098863668 |
| Fax Number: | 9098865542 |
| NPI Enumeration Date: | 05/11/2016 |
| NPI Last Update Date: | 05/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 305R00000X |
| License Number: | E4834 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Preferred Provider Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |