Provider Demographics
NPI:1710079728
Name:HIALEAH FAMILY FOOT CARE CENTER INC
Entity Type:Organization
Organization Name:HIALEAH FAMILY FOOT CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-557-2001
Mailing Address - Street 1:1301 W 68TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4579
Mailing Address - Country:US
Mailing Address - Phone:305-557-2001
Mailing Address - Fax:305-557-2742
Practice Address - Street 1:1301 W 68TH ST
Practice Address - Street 2:STE A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4579
Practice Address - Country:US
Practice Address - Phone:305-557-2001
Practice Address - Fax:305-557-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24979Medicare ID - Type Unspecified
FL1285070001Medicare NSC