Organization
PACIFIC FOOT & ANKLE CENTER - A PODIATRY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID PETERSEN DPM (OWNER PRESIDENT)
(949) 855-1177
Entity
Organization
Contact information
Practice address
24191 PASEO DE VALENCIA, SUITE E, LAGUNA WOODS, CA 92637-3167
(949) 855-1177
(949) 855-6939
Mailing address
24191 PASEO DE VALENCIA, SUITE E, LAGUNA WOODS, CA 92637-3167
(949) 855-1177
(949) 855-6939
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4310
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE7237
RAILROAD MEDI-CARE PIN
CA
Enumeration date
06/04/2006
Last updated
09/28/2010
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