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General NPI Number Information
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NPI Number | 1386677367
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Entity Type | Organization
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Legal Business Name | PEAVINE PODIATRIC PHYSICIANS,LLC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 645 N ARLINGTON AVE STE 660
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City | RENO
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State | NV
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Zip | 89503-4505
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Country | US
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Telephone | 775-746-3338
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Fax | 775-746-3343
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Provider Business Mailing Address
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Address Line | PO BOX 5981
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City | RENO
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State | NV
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Zip | 89513-5981
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Country | US
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Telephone | 775-746-3338
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Fax | 775-746-3343
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Authorized Official
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Title or Position | DPM/OWNER
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Name | DR. COROLINDA SEHELASA HELU
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Credential |
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Telephone | 775-746-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0107
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License Number State | NV
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