Healthcare Provider Details

I. General information

NPI: 1679350060
Provider Name (Legal Business Name): PBC FOOT ANKLE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4362 NORTHLAKE BLVD STE 209
PALM BEACH GARDENS FL
33410-6270
US

IV. Provider business mailing address

796 PATRICK DR
WEST PALM BEACH FL
33406-4434
US

V. Phone/Fax

Practice location:
  • Phone: 561-345-2299
  • Fax: 888-830-1589
Mailing address:
  • Phone: 561-329-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUAN SARDINA
Title or Position: MANAGER
Credential: DPM
Phone: 561-329-2299