=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639398001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST VALLEY FOOT & ANKLE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 01/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13920 W CAMINO DEL SOL #2
-----------------------------------------------------
City | SUN CITY WEST
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85375-4438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-214-1602
-----------------------------------------------------
Fax | 623-544-0701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13920 W CAMINO DEL SOL #2
-----------------------------------------------------
City | SUN CITY WEST
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85375-4438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-214-1602
-----------------------------------------------------
Fax | 623-544-0701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. JAMIE ANNE WEISS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 623-214-1602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 450
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------