Provider Demographics
NPI:1194937011
Name:PASADENA PODIATRY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PASADENA PODIATRY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FERRANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-577-0700
Mailing Address - Street 1:65 N MADISON AVE
Mailing Address - Street 2:SUITE 512
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2035
Mailing Address - Country:US
Mailing Address - Phone:626-577-0700
Mailing Address - Fax:626-796-3989
Practice Address - Street 1:65 N MADISON AVE
Practice Address - Street 2:SUITE 512
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2035
Practice Address - Country:US
Practice Address - Phone:626-577-0700
Practice Address - Fax:626-796-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4035213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5207190001Medicare NSC
CAW16468Medicare PIN