Provider Demographics
NPI:1861548505
Name:TRI CITY PODIATRY CLINIC
Entity type:Organization
Organization Name:TRI CITY PODIATRY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALANIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-795-7099
Mailing Address - Street 1:37138 NILES BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-1616
Mailing Address - Country:US
Mailing Address - Phone:510-795-7099
Mailing Address - Fax:510-795-1978
Practice Address - Street 1:37138 NILES BLVD STE A
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-1616
Practice Address - Country:US
Practice Address - Phone:510-795-7099
Practice Address - Fax:510-795-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2644213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOOE26440Medicaid
CAZZZ86159ZOtherBLUE CROSS
CAZZZ86159ZOtherBLUE SHIELD
0610590001Medicare NSC
CAZZZ86159ZOtherBLUE SHIELD
CAZZZ86159ZOtherBLUE CROSS
CA000E26440Medicare ID - Type UnspecifiedMEDICARE