Provider Demographics
NPI:1851109318
Name:WAVES FOOT AND ANKLE INC.
Entity type:Organization
Organization Name:WAVES FOOT AND ANKLE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SLADE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:805-925-8703
Mailing Address - Street 1:821 E CHAPEL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4618
Mailing Address - Country:US
Mailing Address - Phone:805-925-8703
Mailing Address - Fax:805-349-8315
Practice Address - Street 1:821 E CHAPEL ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4618
Practice Address - Country:US
Practice Address - Phone:805-925-8703
Practice Address - Fax:805-349-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty