Provider Demographics
NPI:1063498749
Name:PAGSOLINGAN, JUAN RODERICK BALZA (DPM)
Entity type:Individual
Prefix:DR
First Name:JUAN RODERICK
Middle Name:BALZA
Last Name:PAGSOLINGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-3432
Mailing Address - Country:US
Mailing Address - Phone:831-385-5471
Mailing Address - Fax:831-385-5940
Practice Address - Street 1:210 CANAL ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3432
Practice Address - Country:US
Practice Address - Phone:831-385-5471
Practice Address - Fax:831-385-5940
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4169213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00E416900Medicaid
CAU72955Medicare UPIN
CA000E41692Medicare ID - Type Unspecified
CAEG577ZMedicare Oscar/Certification