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General NPI Number Information
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NPI Number | 1053968149
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Entity Type | Organization
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Legal Business Name | RYAN MEDINA OAKLEY DPM LLC
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 3625 NW 82ND AVE STE 320
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City | DORAL
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State | FL
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Zip | 33166-7601
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Country | US
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Telephone | 305-930-7934
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Fax | 305-203-4891
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Provider Business Mailing Address
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Address Line | 4131 SW 102ND CT
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City | MIAMI
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State | FL
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Zip | 33165-4943
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Country | US
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Telephone | 305-942-3633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN MEDINA OAKLEY
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Credential | DPM
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Telephone | 305-930-7934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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