Healthcare Provider Details

I. General information

NPI: 1346949906
Provider Name (Legal Business Name): CENTERS FOR ADVANCED FOOT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S MASON RD STE B5
KATY TX
77450-3863
US

IV. Provider business mailing address

12121 RICHMOND AVE STE 415
HOUSTON TX
77082-2439
US

V. Phone/Fax

Practice location:
  • Phone: 281-392-0149
  • Fax:
Mailing address:
  • Phone: 281-531-4100
  • Fax: 281-531-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASIA E LO
Title or Position: OWNER
Credential: DPM
Phone: 281-531-4100