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General NPI Number Information
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NPI Number | 1790004547
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Entity Type | Organization
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Legal Business Name | SERENITY FOOT AND ANKLE CENTER, L.L.C.
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 624 E GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3437
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Country | US
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Telephone | 215-425-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 624 E GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3437
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Country | US
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Telephone | 215-425-0211
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA TERESA IBANEZ
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Credential | D.P.M.
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Telephone | 215-622-8523
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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 | SC006004
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License Number State | PA
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