Healthcare Provider Details

I. General information

NPI: 1710079728
Provider Name (Legal Business Name): HIALEAH FAMILY FOOT CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 68TH ST STE A
HIALEAH FL
33014-4579
US

IV. Provider business mailing address

1301 W 68TH ST STE A
HIALEAH FL
33014-4579
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 Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICARDO REYES
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 305-557-2001