NPI 1285080978

Pacific Coast Podiatry PC

Organisation Preferred Provider Organization San Bernardino, CA

Practice location

Address: 1762 N Waterman Ave, San Bernardino, CA 92404-5130
Phone: (909) 886-3668
Fax: (909) 886-5542

Authorised official

Name: Clayton Gary Johnsen
Title: Owner
Phone: (909) 886-3668

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence E4834 (CA)

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Registry record

NPI: 1285080978
Entity type: Organization
NPI issued: 11 May 2016
Record last updated: 20 Jun 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.