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General NPI Number Information
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NPI Number | 1891932661
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Entity Type | Organization
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Legal Business Name | PODORTIS CORPORATION
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 5841 SW 8TH ST
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City | WEST MIAMI
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State | FL
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Zip | 33144-5035
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Country | US
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Telephone | 305-446-2995
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Fax | 305-446-2996
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Provider Business Mailing Address
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Address Line | 5841 SW 8TH ST
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City | WEST MIAMI
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State | FL
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Zip | 33144-5035
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Country | US
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Telephone | 305-446-2995
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Fax | 305-446-2996
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | LUIS CARBAJAL
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Credential | LPED, LOF,CPOA
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Telephone | 305-446-2995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | OFA275
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | ORF235
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PED160
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License Number State | FL
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