Healthcare Provider Details

I. General information

NPI: 1104410539
Provider Name (Legal Business Name): BILLET PODIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9755 N 90TH ST STE A110
SCOTTSDALE AZ
85258-5174
US

IV. Provider business mailing address

6710 N 47TH AVE STE 8
GLENDALE AZ
85301-4111
US

V. Phone/Fax

Practice location:
  • Phone: 480-391-9193
  • Fax:
Mailing address:
  • Phone: 833-224-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: VAHAN OGANESYAN
Title or Position: COO
Credential:
Phone: 833-224-5538