DR. NICOLE MARIE SURDOCK (NPI# 1174674436) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174674436 |
| Entity Type | Individual |
| Full Name | DR. NICOLE MARIE SURDOCK |
| Credential | D.P.M. |
| Practice Address |
47 Penny Ln Suite 1 Watsonville CA 95076-6055 |
| Mailing Address |
102 Pebble Beach Ct Aptos CA 95003-5724 |
| Practice Telephone | 8317288844 |
| Mailing Telephone | 5104358472 |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2012-02-07 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213EP1101X |
Podiatrist Specialization: Primary Podiatric Medicine |
E4802 | CA | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
EL 1671 | CA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | D.P.M. RESIDENT'S LICENSE | EL 1671 | 01 |
| CA | CALIFORNIA STATE LICENSE- DOCOTR OF PODIATRIC MEDICINE AND ANKLE | E 4802 | 01 |
| Street Address |
47 PENNY LN SUITE 1 |
| City | WATSONVILLE |
| State | CA |
| Zip Code | 95076-6055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801858048 | Mark Ian Brenis | Podiatrist | 47 Penny Ln, Suite 1, Watsonville, CA 95076-6055 | 2006-04-04 |
| 1235341405 | Gary B. Shenfield | Dentist | 47 Penny Ln, Ste. 2, Watsonville, CA 95076-6055 | 2007-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841757515 | Vicky E Gonzalez | Case Manager/Care Coordinator | 2714 Freedom Blvrd, Watsonville, CA 95076 | 2019-02-28 |
| 1861987059 | Encompass Community Services | Community/Behavioral Health | 2714 Freedom Blvd., Freedom, CA 95076 | 2018-06-29 |
| 1134617798 | Haven of Hope, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 107 Pauline Dr, Watsonville, CA 95076 | 2018-04-28 |
| 1346743911 | Kathleen Long | Physician Assistant | 2468, 75 Nielson St, Watsonville, CA 95076 | 2018-03-09 |
| 1811403603 | Hieu Thi Thanh Nguyen Boulom | Pharmacist | 2810 Freedom Blvd, Watsonview, CA 95076 | 2017-12-16 |
| 1649798398 | Jonathon Rank | Counselor | 335 East Lake Ave, Watsonville, CA 95076 | 2017-09-01 |
| 1841653318 | Cristina Guzman | Registered Nurse | 195 Aviation Way, Ste 200, Watsonville, CA 95076 | 2016-04-01 |
| 1013388974 | Salud Para La Gente | Clinic/Center | 195 Aviation Way, Suite 200, Watsonville, CA 95076 | 2015-10-16 |
| 1386025757 | Yaseer Yousuf Parupia | Podiatrist | 47 Penny Lane, Suite 1, Watsonville, CA 95076 | 2015-06-11 |
| 1093100935 | Diana Perezchica | Counselor | 20716 Freedom Blv, Watsonville, CA 95076 | 2015-03-30 |
| Find all providers in zip 95076 | ||||
| Taxonomy Code | 213EP1101X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Primary Podiatric Medicine |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245511104 | Ashika, Inc | Podiatrist | 65 Nielson St, Suite 125, Watsonville, CA 95076-2491 | 2011-09-06 |
| 1801926274 | William E. Hopkins Dpm | Podiatrist | 47 Penny Ln Ste 1, Watsonville, CA 95076-6055 | 2007-03-06 |
| 1679625636 | William E. Hopkins | Podiatrist | 47 Penny Ln Ste 1, Watsonville, CA 95076-6055 | 2007-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760017438 | Karen Romines Podiatry Incorporated | Podiatrist | 10100 Fair Oaks Blvd Ste A, Fair Oaks, CA 95628-7154 | 2020-03-03 |
| 1033759709 | Igal Palma | Podiatrist | 2987 Grant St, Concord, CA 94520-4640 | 2020-01-10 |
| 1376013730 | Fatah Paramole Dpm LLC | Podiatrist | 561 N Alta Ave Ste A, Dinuba, CA 93618-3200 | 2018-11-28 |
| 1053893347 | Sacramento Foot and Ankle Center, Inc. | Podiatrist | 5030 J St Ste 300, Sacramento, CA 95819 | 2018-09-04 |
| 1669988655 | Happy Feet Podiatry P.C. | Podiatrist | 601 E Yorba Linda Blvd Ste 6, Placentia, CA 92870-3006 | 2017-12-28 |
| 1023549987 | Carl Christenson, Dpm | Podiatrist | 7687 N 9th St, Fresno, CA 93720-2629 | 2017-03-22 |
| 1598203788 | Bermar Group Inc | Podiatrist | 7952 Genesta Ave, Lake Balboa, CA 91406-1624 | 2017-02-07 |
| 1063871234 | Gregory W Herb | Podiatrist | 195 Blossom Hill Rd Lot 148, San Jose, CA 95123-2349 | 2016-02-17 |
| 1053791509 | Grandy Podiatry Group | Podiatrist | 730 46th St, Sacramento, CA 95819-3149 | 2015-05-30 |
| 1801201389 | Alycia Chen | Podiatrist | 305 South Dr Ste 6, Mountain View, CA 94040-4207 | 2014-06-24 |
| Find all providers with the same taxonomy | ||||
| City | WATSONVILLE |
| Zip Code | 95076 |
Please comment or provide details below to improve the information on DR. NICOLE MARIE SURDOCK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.