Healthcare Provider Details

I. General information

NPI: 1275623043
Provider Name (Legal Business Name): VIRGINIA FOOTCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 JEFFERSON DAVIS HWY SUITE 114
STAFFORD VA
22554-1767
US

IV. Provider business mailing address

2848 JEFFERSON DAVIS HWY SUITE 114
STAFFORD VA
22554-1767
US

V. Phone/Fax

Practice location:
  • Phone: 540-720-0674
  • Fax: 540-720-8044
Mailing address:
  • Phone: 540-720-0674
  • Fax: 540-720-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103300847
License Number StateVA

VIII. Authorized Official

Name: DR. JOEL CRISTOBAL ZARZUELA
Title or Position: OWNER
Credential: DPM
Phone: 540-720-0674