Organization
SAN BERNARDINO FOOT CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA CUEVAS (OFFICE MANAGER)
(909) 882-3800
Entity
Organization
Contact information
Practice address
2095 N WATERMAN AVE, SAN BERNARDINO, CA 92404-4834
(909) 882-3800
(909) 882-3380
Mailing address
2095 N WATERMAN AVE, SAN BERNARDINO, CA 92404-4834
(909) 882-3800
(909) 882-3380
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4416
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E44161
—
CA
05
—
0253335
—
CA
01
—
CI863B
MEDICARE PTAN
CA
01
—
DD297Z
MEDICARE INDIVIDUAL
CA
Enumeration date
07/06/2006
Last updated
02/21/2024
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