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General NPI Number Information
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NPI Number | 1386389849
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW FOOT & ANKLE LLC
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 5432 E SOUTHERN AVE STE 101B
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City | MESA
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State | AZ
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Zip | 85206-2772
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Country | US
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Telephone | 480-210-3336
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Fax | 480-210-3339
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Provider Business Mailing Address
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Address Line | 3927 E DOVER ST
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City | MESA
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State | AZ
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Zip | 85205-6111
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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
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Name | DR. JACOB H NELSON
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Credential | DPM
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Telephone | 602-206-9660
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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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