Healthcare Provider Details

I. General information

NPI: 1962546549
Provider Name (Legal Business Name): THE FOOT INSTITUTE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W CASTELLANO DR
EL PASO TX
79912-6119
US

IV. Provider business mailing address

114 W CASTELLANO DR
EL PASO TX
79912-6119
US

V. Phone/Fax

Practice location:
  • Phone: 915-532-3721
  • Fax: 915-532-3724
Mailing address:
  • Phone: 915-532-3721
  • Fax: 915-532-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1174
License Number StateTX

VIII. Authorized Official

Name: DR. EFREN B. DE LA ROSA
Title or Position: CEO
Credential: DPM
Phone: 915-532-3721