Healthcare Provider Details

I. General information

NPI: 1821749615
Provider Name (Legal Business Name): TOE-TAL FAMILY FOOTCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 SALMON CREEK DR
LAS VEGAS NV
89129-6188
US

IV. Provider business mailing address

2604B EL CAMINO REAL # 311
CARLSBAD CA
92008-1214
US

V. Phone/Fax

Practice location:
  • Phone: 702-956-3750
  • Fax: 702-233-8928
Mailing address:
  • Phone: 702-956-3750
  • Fax: 702-233-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH G MELENDEZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 760-889-1941