# PROVIDENCE PODIATRY CARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Podiaty Care, Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033881735
- **Authorized official:** EDDIE AVILA (OWNER/ADMINISTRATOR)
- **Authorized official phone:** (909) 944-0486

## Contact information

- **Practice address:** 10621 CHURCH ST STE 120, RANCHO CUCAMONGA, CA 91730-6834
- **Practice address phone:** (909) 944-0481
- **Practice address fax:** (909) 944-3161
- **Mailing address:** 10621 CHURCH ST STE 120, RANCHO CUCAMONGA, CA 91730-6834
- **Mailing address phone:** (909) 944-0481
- **Mailing address fax:** (909) 944-3161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 09/30/2021
- **Last updated:** 10/04/2021