Healthcare Provider Details

I. General information

NPI: 1518546449
Provider Name (Legal Business Name): UPSCALE FOOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. VALLE VERDE PASEO REAL 1014 SUITE 1
PONCE PR
00716-0072
US

IV. Provider business mailing address

PO BOX 8028
BAYAMON PR
00960-8028
US

V. Phone/Fax

Practice location:
  • Phone: 787-501-5941
  • Fax:
Mailing address:
  • Phone: 813-753-6382
  • Fax:

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: DYMARIE BURGOS
Title or Position: ASISTENTE ADMINISTRATIVO
Credential:
Phone: 787-399-3755