Provider Demographics
NPI:1326776311
Name:AJ FOOT AND ANKLE CARE, LLC
Entity Type:Organization
Organization Name:AJ FOOT AND ANKLE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOORI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:469-398-1972
Mailing Address - Street 1:2301 OHIO DR
Mailing Address - Street 2:STE 182
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:469-398-1972
Mailing Address - Fax:737-247-7483
Practice Address - Street 1:2301 OHIO DR
Practice Address - Street 2:STE 182
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:469-398-1972
Practice Address - Fax:737-247-7483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty