=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902645799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPPING STONE PODIATRY ENTERPRISE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2024
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1424 W PRICE RD STE A2
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-8672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-617-0139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7049 WESTWIND DR APT 8005
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79912-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-505-0011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST
-----------------------------------------------------
Name | DR. NICCALE ALIBIN
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 915-505-0011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------