Healthcare Provider Details

I. General information

NPI: 1700691672
Provider Name (Legal Business Name): PREMIER PODIATRY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E ALTAMONTE DR. STE #205
ALTAMONTE SPRINGS FL
32701-4810
US

IV. Provider business mailing address

616 E ALTAMONTE DR STE 205
ALTAMONTE SPRINGS FL
32701-4810
US

V. Phone/Fax

Practice location:
  • Phone: 407-813-2413
  • Fax: 407-792-1019
Mailing address:
  • Phone: 407-813-2413
  • Fax: 407-378-6017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CRISTINA MARIA CORRALES-AGUILAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-813-2413