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General NPI Number Information
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NPI Number | 1679628366
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Entity Type | Organization
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Legal Business Name | FOOTFIT SOUTHWEST, INC.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2929 MONTANA AVE
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City | EL PASO
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State | TX
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Zip | 79903-2409
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Country | US
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Telephone | 915-566-7463
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Fax | 915-566-9223
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Provider Business Mailing Address
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Address Line | 2929 MONTANA AVE
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City | EL PASO
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State | TX
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Zip | 79903-2409
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Country | US
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Telephone | 915-566-7463
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Fax | 915-566-9223
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. YURI GOMEZ
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Credential | CPED
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Telephone | 915-566-7463
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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 | 0093978
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License Number State | TX
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