Healthcare Provider Details

I. General information

NPI: 1801013149
Provider Name (Legal Business Name): TOE-TAL FAMILY FOOTCARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 GREEN OAK RD
VISTA CA
92081-8740
US

IV. Provider business mailing address

2604 EL CAMINO REAL STE B #311
CARLSBAD CA
92008-1205
US

V. Phone/Fax

Practice location:
  • Phone: 702-524-0367
  • Fax: 760-943-8816
Mailing address:
  • Phone: 702-524-0367
  • Fax: 760-943-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberNV9101
License Number StateNV

VIII. Authorized Official

Name: DR. MARK S. MILLER
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 702-524-0367