Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4766 | CA |
Y | 222Z00000X | Podiatrist | E4766 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E4766 | CA |
N | 111NR0200X | Radiology | RHC00201402 | CA |
N | 213ER0200X | Radiology | RHC00201402 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E4766 | CA |
N | 213ES0131X | Foot Surgery | E4766 | CA |
NPI | 1528245800 |
---|---|
Provider Name | Dr. Denten E Eldredge |
First Address | Pomona, CA 91766-2007 |
Second Address | Pomona, CA 91766-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2008 |
Last Update Date | 17/12/2021 |