| NPI | 1033881735 |
|---|---|
| Doing Business As | PROVIDENCE PODIATY CARE, INC |
| Entity Type | Organization |
| Authorized Contact | EDDIE AVILA Owner/Administrator 909-944-0486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2021-10-04 |