Healthcare Provider Details

I. General information

NPI: 1649315037
Provider Name (Legal Business Name): ASSOCIATES FAMILY FOOT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BELMONT AVE
YOUNGSTOWN OH
44505-1862
US

IV. Provider business mailing address

PO BOX 128
GIRARD OH
44420-0128
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-8690
  • Fax: 330-759-3988
Mailing address:
  • Phone: 330-759-8690
  • Fax: 330-759-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003113R
License Number StateOH

VIII. Authorized Official

Name: CARMELITA RONQUILLO REYES
Title or Position: MANAGING MEMBER
Credential: DPM
Phone: 330-759-8690