Provider Demographics
NPI:1225588783
Name:SOLE CARE MOBILE PODIATRY, PLLC
Entity Type:Organization
Organization Name:SOLE CARE MOBILE PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JANOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-869-2971
Mailing Address - Street 1:11475 E HELM DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-1887
Mailing Address - Country:US
Mailing Address - Phone:480-247-6494
Mailing Address - Fax:480-247-6643
Practice Address - Street 1:16427 N SCOTTSDALE RD STE 434
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-7103
Practice Address - Country:US
Practice Address - Phone:480-247-6494
Practice Address - Fax:480-247-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-09
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
AZ0829261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ219991Medicaid