Organization
SANTA ANA TUSTIN PODIATRY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIRGIL THEODORE HERNANDEZ DPM (PRESIDENT)
(714) 265-5824
Entity
Organization
Contact information
Practice address
661 W 1ST ST STE D, TUSTIN, CA 92780-2939
(714) 265-5824
(714) 384-3897
Mailing address
661 W 1ST ST STE D, TUSTIN, CA 92780-2939
(714) 265-5824
(714) 384-3897
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Enumeration date
09/05/2012
Last updated
10/03/2014
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