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General NPI Number Information
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NPI Number | 1659160281
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Entity Type | Organization
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Legal Business Name | SEVILLE PODIATRY SERVICES LLC
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 6392 EQUESTRIAN TRL
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City | MEDINA
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State | OH
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Zip | 44256-7421
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Country | US
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Telephone | 330-975-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 6392 EQUESTRIAN TRL
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City | MEDINA
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State | OH
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Zip | 44256-7421
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Country | US
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Telephone | 330-975-0004
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JONATHAN M. MOSS
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Credential | DPM
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Telephone | 714-404-5641
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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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