# PROVIDENCE PODIATRY CARE, INC

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

## Provider details

- **NPI number:** 1376202986
- **Authorized official:** EDDIE AVILA (SECRETARY/TREASUER)
- **Authorized official phone:** (909) 244-7430

## Contact information

- **Practice address:** 473 E CARNEGIE DRIVE, SUITE 200, SAN BERNARDINO, CA 92408
- **Practice address phone:** (909) 244-7430
- **Practice address fax:** (909) 495-1380
- **Mailing address:** 473 E CARNEGIE DRIVE, SUITE 200, SAN BERNARDINO, CA 92408
- **Mailing address phone:** (909) 244-7430
- **Mailing address fax:** (909) 495-1380

## Taxonomy

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

## Other

- **Enumeration date:** 12/10/2021
- **Last updated:** 06/21/2023