Provider Demographics
NPI:1083875496
Name:TOTAL FOOT CARE CLINIC INC
Entity Type:Organization
Organization Name:TOTAL FOOT CARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-818-7070
Mailing Address - Street 1:3300 W 84TH ST
Mailing Address - Street 2:BAY # 16
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4903
Mailing Address - Country:US
Mailing Address - Phone:305-818-7070
Mailing Address - Fax:305-818-7080
Practice Address - Street 1:3300 W 84TH ST
Practice Address - Street 2:BAY # 16
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4903
Practice Address - Country:US
Practice Address - Phone:305-818-7070
Practice Address - Fax:305-818-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2330332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6129060001Medicare NSC