Organization Name: | MOBILE PODIATRY |
NPI Number: | 1023473139 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DESIREE M REYES (OWNER) |
Mailing Address: | 704 Windy Way Unit 206 Newport News |
State: | VA US |
Postal Code: | 236025698 |
Phone Number: | 4437357542 |
Fax Number: | |
NPI Enumeration Date: | 12/17/2015 |
NPI Last Update Date: | 12/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP1100X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Podiatric |
Taxonomy Definition: |