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PACIFIC COAST PODIATRY PC
NPI 1285080978
Preferred Provider Organization in San Bernardino, CA

Active since May 11, 2016
1762 N WATERMAN AVE, SAN BERNARDINO, CA 92404(909) 886-3668(909) 886-5542 Get Directions Write a Review

NPPES record last updated: June 20, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Pacific Coast Podiatry Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PACIFIC COAST PODIATRY PC (NPI 1285080978) is a healthcare organization registered as a preferred provider organization in San Bernardino, California and active in the NPI registry since May 2016. The organization maintains a secondary practice location in San Clemente and lists Clayton Gary Johnsen, Owner, as its authorized official.

NPPES Registry Identity

NPI1285080978
Entity TypeOrganization
Primary Taxonomy305R00000X
Legal Business NamePACIFIC COAST PODIATRY PC
Location Address1762 N WATERMAN AVESan Bernardino, CA 92404-5130
Mailing Address1762 N Waterman AveSan Bernardino, CA 92404-5130 · (909) 886-3668 · Fax (909) 886-5542
Phone(909) 886-3668
Fax(909) 886-5542
Organization SubpartNo
Authorized OfficialClayton Gary JohnsenOwner · (909) 886-3668
Enumeration DateMay 11, 2016
Last NPPES UpdateJune 20, 2022
NPPES CertifiedJune 20, 2022
✔ NPI 1285080978 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPreferred Provider OrganizationManaged Care Organizations
Taxonomy Code305R00000X
License✔ Licensed in CA · E4834
Definition
A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
1762 N WATERMAN AVE, San Bernardino, CA 92404
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Secondary Practice Location 1

Location 1657 Camino De Los Mares Ste 133San Clemente, CA 92673-2810 · Phone (909) 886-3668 · Fax (909) 886-5542

Other Identifiers 1

Other1285080978Npi

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CLAYTON GARY JOHNSEN D.P.M.
Podiatrist (Foot & Ankle Surgery)
1762 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (909) 886-3668
DR. RICHARD D. GARCIA D.D.S.
Dentist (General Practice)
1762 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (909) 882-2032
MOELLMER, INC.
Podiatrist (Foot & Ankle Surgery)
1762 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (909) 886-3668

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pacific Coast Podiatry PC's NPI number?

The NPI number for Pacific Coast Podiatry PC is 1285080978. It was assigned to this organization in the NPPES registry on May 11, 2016.

Where is Pacific Coast Podiatry PC located?

Pacific Coast Podiatry PC is located at 1762 N Waterman Ave, San Bernardino, CA 92404. The listed phone number is (909) 886-3668.

What is Pacific Coast Podiatry PC's specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

When was this NPI record last updated?

The NPPES record for Pacific Coast Podiatry PC was last updated on June 20, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.