Dr. Nicole Marie Surdock
Foot & Ankle Surgery Primary Podiatric Medicine
47 Penny Ln Suite 1
Watsonville
, California 95076-6055
Dr. Nicole Marie Surdock
Foot & Ankle Surgery Primary Podiatric Medicine
47 Penny Ln Suite 1
Watsonville
, California 95076-6055
(510) 435-8472
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About
Features
Specialties
- Primary Podiatric Medicine
- Foot & Ankle Surgery
Languages spoken
- English
Location
First Address
- Dr. Nicole Marie Surdock
- 102 Pebble Beach Ct
- Aptos, CA
- Zip : 95003-5724
- Phone : (510) 435-8472
Second Address
- Dr. Nicole Marie Surdock
- 47 Penny Ln Suite 1
- Watsonville, CA
- Zip : 95076-6055
- Phone : (831) 728-8844
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 213EP1101X | Primary Podiatric Medicine | E4802 | CA |
| N | 213ES0103X | Foot & Ankle Surgery | EL 1671 | CA |
National Provider Identifier
| NPI | 1174674436 |
|---|---|
| Provider Name | Dr. Nicole Marie Surdock |
| First Address | Aptos, CA 95003-5724 |
| Second Address | Watsonville, CA 95076-6055 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/01/2007 |
| Last Update Date | 07/02/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| E 4802 | CALIFORNIA STATE LICENSE- DOCOTR OF PODIATRIC MEDICINE AND ANKLE SURGERY (01) | CA |
| EL 1671 | D.P.M. RESIDENT'S LICENSE (01) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.