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General NPI Number Information
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NPI Number | 1801449293
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Entity Type | Organization
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Legal Business Name | REBECA RAY-GILLIS DPM, PLLC
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 3314 W PARK RD
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City | HOLLYWOOD
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State | FL
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Zip | 33021-4337
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Country | US
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Telephone | 954-290-2406
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Fax |
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Provider Business Mailing Address
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Address Line | 3314 W PARK RD
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City | HOLLYWOOD
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State | FL
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Zip | 33021-4337
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Country | US
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Telephone | 954-290-2406
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | REBECA RAY-GILLIS
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Credential | DPM
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Telephone | 954-290-2406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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