Provider Demographics
NPI:1063753036
Name:ANNALISA Y. CO, PODIATRY CORPORATION
Entity type:Organization
Organization Name:ANNALISA Y. CO, PODIATRY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:916-487-7845
Mailing Address - Street 1:1440 KINGSFORD DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6165
Mailing Address - Country:US
Mailing Address - Phone:916-487-7845
Mailing Address - Fax:916-914-2303
Practice Address - Street 1:5931 STANLEY AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3846
Practice Address - Country:US
Practice Address - Phone:916-481-4389
Practice Address - Fax:916-481-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4613213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty