| NPI | 1588965586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMIKA MICHELLE BOLDEN RAVENELL Dpm/ Owner 916-215-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SC POD 607) |
| Enumeration Date | 2010-11-07 |
| Last Update Date | 2013-12-13 |