Provider Demographics
NPI:1083892319
Name:ESTRELLA MOUNTAIN FOOT & ANKLE INC
Entity Type:Organization
Organization Name:ESTRELLA MOUNTAIN FOOT & ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-547-2800
Mailing Address - Street 1:13065 W MCDOWELL RD
Mailing Address - Street 2:STE A103
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6439
Mailing Address - Country:US
Mailing Address - Phone:623-547-2800
Mailing Address - Fax:
Practice Address - Street 1:255 N CENTRAL BLVD
Practice Address - Street 2:#4
Practice Address - City:QUARTZSIDE
Practice Address - State:AZ
Practice Address - Zip Code:85346
Practice Address - Country:US
Practice Address - Phone:928-927-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0607213ES0103X
AZ0580213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty