Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E4169 | CA |
N | 222Z00000X | Podiatrist | E4169 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E4169 | CA |
NPI | 1063498749 |
---|---|
Provider Name | Dr. Juan Roderick Balza Pagsolingan |
First Address | King City, CA 93930-3432 |
Second Address | King City, CA 93930-3432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 09/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00E416900 | (05) | CA |
U72955 | (02) | CA |