1326178286 NPI number — FOOTOMAKI ORO VALLEY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326178286 NPI number — FOOTOMAKI ORO VALLEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOTOMAKI ORO VALLEY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326178286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7705 N ORACLE RD
Provider Second Line Business Mailing Address:
#125
Provider Business Mailing Address City Name:
ORO VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85704-6562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-797-9266
Provider Business Mailing Address Fax Number:
520-797-9433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7705 N ORACLE RD
Provider Second Line Business Practice Location Address:
#125
Provider Business Practice Location Address City Name:
ORO VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85704-6562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-797-9266
Provider Business Practice Location Address Fax Number:
520-797-9433
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GIFFIN
Authorized Official First Name:
RITA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
520-797-9266

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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