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General NPI Number Information
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NPI Number | 1699270108
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Entity Type | Organization
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Legal Business Name | MOBILE FOOT DOC LLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 7801 AIRPORT PULLING RD N
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City | NAPLES
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State | FL
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Zip | 34109-1717
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Country | US
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Telephone | 239-567-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 NW 100TH AVE
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-1550
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARCELO VILLALBA
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Credential | DPM
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Telephone | 863-242-9296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2969
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License Number State | FL
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