Provider Demographics
NPI:1528060548
Name:CO, ANNALISA Y (DPM)
Entity type:Individual
Prefix:
First Name:ANNALISA
Middle Name:Y
Last Name:CO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5931 STANLEY AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3846
Mailing Address - Country:US
Mailing Address - Phone:916-244-7630
Mailing Address - Fax:916-244-7631
Practice Address - Street 1:5931 STANLEY AVE
Practice Address - Street 2:STE 4
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3846
Practice Address - Country:US
Practice Address - Phone:916-244-7630
Practice Address - Fax:916-244-7631
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2016-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE4613213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00E46130Medicare ID - Type Unspecified