Provider Demographics
NPI:1174949226
Name:NAPA SOLANO FOOT AND ANKLE
Entity type:Organization
Organization Name:NAPA SOLANO FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SKY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-608-6469
Mailing Address - Street 1:1460 N CAMINO ALTO
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2567
Mailing Address - Country:US
Mailing Address - Phone:707-644-4049
Mailing Address - Fax:707-644-4687
Practice Address - Street 1:1460 N CAMINO ALTO
Practice Address - Street 2:SUITE 101
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2567
Practice Address - Country:US
Practice Address - Phone:707-644-4049
Practice Address - Fax:707-644-4687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA 121965Medicare PIN
1528245800Medicare UPIN