Healthcare Provider Details

I. General information

NPI: 1023013653
Provider Name (Legal Business Name): PODIATRY CENTER, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 AVE FERNANDEZ JUNCOS STOP 20
SANTURCE PR
00909-2649
US

IV. Provider business mailing address

PO BOX 19657
SAN JUAN PR
00910-1657
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-0871
  • Fax: 787-724-0886
Mailing address:
  • Phone: 787-724-0871
  • Fax: 787-724-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0039
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1302060001
License Number StatePR

VIII. Authorized Official

Name: MRS. NORMA DIAZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-724-0871