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General NPI Number Information
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NPI Number | 1922550722
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Entity Type | Organization
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Legal Business Name | SOUTHWEST FOOT CARE AND ASSOCIATES
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 7711 SAN JACINTO PL SUITE 200
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City | PLANO
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State | TX
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Zip | 75024-3294
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Country | US
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Telephone | 214-396-7324
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Fax | 972-497-2580
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Provider Business Mailing Address
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Address Line | 7711 SAN JACINTO PL SUITE 200
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City | PLANO
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State | TX
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Zip | 75024-3294
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Country | US
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Telephone | 214-396-7324
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Fax | 972-497-2580
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Authorized Official
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Title or Position | OWNER
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Name | REZA MOBARAK
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Credential | DPM
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Telephone | 214-396-7324
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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 | 1714
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License Number State | TX
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