Provider Demographics
NPI:1427819820
Name:VALLEYFOOTDOCTOR, INC
Entity type:Organization
Organization Name:VALLEYFOOTDOCTOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDYAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:661-945-8700
Mailing Address - Street 1:43713 20TH ST W STE 5
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4628
Mailing Address - Country:US
Mailing Address - Phone:661-945-8700
Mailing Address - Fax:661-945-8757
Practice Address - Street 1:43713 20TH ST W STE 5
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4628
Practice Address - Country:US
Practice Address - Phone:661-945-8700
Practice Address - Fax:661-945-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty