# DISORDERS OF THE FOOT AND ANKLE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184650921
- **Authorized official:** SHARON MARIE DREEBEN MD (CEO)
- **Authorized official phone:** (858) 488-4008

## Contact information

- **Practice address:** 331 SEA RIDGE DRIVE, LA JOLLA, CA 92037
- **Practice address phone:** (858) 488-4008
- **Practice address fax:** (877) 297-2958
- **Mailing address:** 5580 LA JOLLA BLVD \#55, LA JOLLA, CA 92037
- **Mailing address phone:** (858) 488-4008
- **Mailing address fax:** (877) 297-2958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | G67534 | CA | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | NULL | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 06/23/2006
- **Last updated:** 01/13/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G675340 | — | CA |
| 01 | — | 200045199 | RAILROAD MEDICARE PTAN | CA |