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General NPI Number Information
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NPI Number | 1679484430
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Entity Type | Organization
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Legal Business Name | DIABETIC SHOE SOURCE AND DME
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Dates
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Enumeration Date | 09/12/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 907 CHELSEA ST STE G
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City | EL PASO
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State | TX
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Zip | 79903-4912
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Country | US
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Telephone | 915-317-1222
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Fax | 915-317-1005
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Provider Business Mailing Address
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Address Line | 907 CHELSEA ST STE G
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City | EL PASO
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State | TX
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Zip | 79903-4912
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Country | US
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Telephone | 915-317-1222
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Fax | 915-317-1005
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Authorized Official
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Title or Position | MEMBER
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Name | MIA NOLASCO
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Credential |
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Telephone | 915-317-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | NULL
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