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General NPI Number Information
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NPI Number | 1083954804
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Entity Type | Organization
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Legal Business Name | SIERRA VISTA FAMILY FOOTCARE PC
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 4235 S MOHAVE DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85650-8429
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Country | US
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Telephone | 520-803-0509
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3345
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City | SIERRA VISTA
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State | AZ
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Zip | 85636-3345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. RICHARD FRED COHEN
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Credential | D.P.M.
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Telephone | 520-803-0509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0430
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License Number State | AZ
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