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Organization

FOOT FITNESS CENTER PODIATRY GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RICHARD GRENIER DPM (OWNER)
(714) 777-2658
Entity
Organization

Contact information

Practice address
4976 LAKEVIEW AVE, YORBA LINDA, CA 92886-4158
(714) 777-2658
(714) 777-1055
Mailing address
4976 LAKEVIEW AVE, YORBA LINDA, CA 92886-4158
(714) 777-2658
(714) 777-1055

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E2097
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
#E2097
MEDICARE ID-PROVIDER #
01
1124264833
NPI
01
1588637193
NPI INDIVIDUAL
01
5568080001
DME
CA
01
BC718
PTAN - INDIVIDUAL
CA
01
BC719
PTAN
CA
01
D03050
RAILROAD MEDICARE
CA
01
P00669656
RAILROAD MEDICARE
CA
Enumeration date
12/30/2008
Last updated
05/30/2013
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