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General NPI Number Information
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NPI Number | 1326919853
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Entity Type | Organization
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Legal Business Name | PODIATRY BOUTIQUE PLLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 6835 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89117-1635
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Country | US
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Telephone | 702-530-2283
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Fax | 702-532-2283
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Provider Business Mailing Address
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Address Line | 6835 W CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89117-1635
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Country | US
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Telephone | 702-530-2283
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Fax | 702-532-2283
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Authorized Official
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Title or Position | OWNER
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Name | ANMY VU
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Credential | DPM
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Telephone | 702-530-2283
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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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