MEDICARE: PODIATRY CENTER, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1302060001	PR
2	213ES0131X	Foot Surgery Podiatrist	0039	PR

General Provider Information

NPI Number	:	1023013653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY CENTER, PSC

Provider Business Mailing Address
First Line	:	PO BOX 19657
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-1657
Country	:	US
Telephone Number	:	787-724-0871
Fax Number	:	787-724-0886

Provider Business Practice Location Address
First Line	:	1413 AVE FERNANDEZ JUNCOS
Second Line	:	STOP 20
City	:	SANTURCE
State	:	PR
Zip	:	00909-2649
Country	:	US
Telephone Number	:	787-724-0871
Fax Number	:	787-724-0886

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. NORMA DIAZ
Credential	:
Telephone Number	:	787-724-0871

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	04/26/2011

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