Healthcare Provider Details

I. General information

NPI: 1871678979
Provider Name (Legal Business Name): SOUTHWEST FOOT INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 E MCDOWELL RD SUITE 121
PHOENIX AZ
85006-2503
US

IV. Provider business mailing address

926 E MCDOWELL RD SUITE 121
PHOENIX AZ
85006-2503
US

V. Phone/Fax

Practice location:
  • Phone: 602-340-8686
  • Fax: 602-340-8061
Mailing address:
  • Phone: 602-340-8686
  • Fax: 602-340-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberAZ0154
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN A PINEDO
Title or Position: PODIATRIST
Credential: DPM
Phone: 602-340-8686