Healthcare Provider Details

I. General information

NPI: 1316226152
Provider Name (Legal Business Name): DIABETIC FOOT CARE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 E 49TH ST
HIALEAH FL
33013-1853
US

IV. Provider business mailing address

182 E 49TH ST
HIALEAH FL
33013-1853
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-2001
  • Fax: 305-557-2742
Mailing address:
  • Phone: 305-557-2001
  • Fax: 305-557-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MARIO A FERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-557-2001