Provider Demographics
NPI:1326178286
Name:FOOTOMAKI ORO VALLEY LLC
Entity Type:Organization
Organization Name:FOOTOMAKI ORO VALLEY LLC
Other - Org Name:FOOT SOLUTIONS ORO VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-797-9266
Mailing Address - Street 1:7705 N ORACLE RD
Mailing Address - Street 2:#125
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6562
Mailing Address - Country:US
Mailing Address - Phone:520-797-9266
Mailing Address - Fax:520-797-9433
Practice Address - Street 1:7705 N ORACLE RD
Practice Address - Street 2:#125
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85704-6562
Practice Address - Country:US
Practice Address - Phone:520-797-9266
Practice Address - Fax:520-797-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5918760001Medicare NSC