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General NPI Number Information
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NPI Number | 1386140242
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Entity Type | Organization
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Legal Business Name | ELITE STRIDE FOOT AND ANKLE CENTER INC
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Dates
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Enumeration Date | 03/31/2018
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Last Update Date | 11/15/2018
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Provider Practice Location Address
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Address Line | 12300 ALT A1A STE 118
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-2211
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Country | US
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Telephone | 561-626-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 11714 62ND LN N
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-1835
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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 | OWNER/PRESIDENT
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Name | DR. LADY PAULA DEJESUS
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Credential | DPM
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Telephone | 561-626-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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