Provider Demographics
NPI:1528555281
Name:PARKVIEW PODIATRY
Entity type:Organization
Organization Name:PARKVIEW PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARGULA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:707-263-9595
Mailing Address - Street 1:175 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-4803
Mailing Address - Country:US
Mailing Address - Phone:707-263-9595
Mailing Address - Fax:
Practice Address - Street 1:1255 N DUTTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4663
Practice Address - Country:US
Practice Address - Phone:707-596-2660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKVIEW PODIATRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty