Healthcare Provider Details

I. General information

NPI: 1740480359
Provider Name (Legal Business Name): FOOTOMAKI TUCSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E GRANT RD # 115
TUCSON AZ
85712
US

IV. Provider business mailing address

4444 E GRANT RD # 115
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-8650
  • Fax: 520-795-8687
Mailing address:
  • Phone: 520-795-8650
  • Fax: 520-795-8687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RITA M GIFFIN
Title or Position: MANAGER
Credential: CPED
Phone: 520-795-8650