| Organization Name: | PACIFIC FOOT & ANKLE CENTER - A PODIATRY CORPORATION |
| NPI Number: | 1780623173 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID PETERSEN (OWNER PRESIDENT) |
| Mailing Address: | 24191 Paseo De Valencia Suite E Laguna Woods |
| State: | CA US |
| Postal Code: | 926373167 |
| Phone Number: | 9498551177 |
| Fax Number: | 9498556939 |
| NPI Enumeration Date: | 06/04/2006 |
| NPI Last Update Date: | 09/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | E4310 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |