Provider Information for 1144393638
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Mr. IVAN WILLIAM FOOTE L.M.F.T.
Sex: Male
NPI: 1144393638
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
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NPI | 1144393638 | ||||||||
Enumeration Date | 2006-11-15 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | PO BOX 7814 SANTA CRUZ, CA 95061-7814 United States Phone: 831-475-5826 | Fax: | ||||||||
Primary Practice Address | 232 E GISH RD SAN JOSE, CA 95112-4706 United States Phone: 408-876-4104 | Fax:408-876-4230 | ||||||||
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