Provider Demographics
NPI:1790098036
Name:VALLEY FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:VALLEY FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-240-3974
Mailing Address - Street 1:395 N HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3373
Mailing Address - Country:US
Mailing Address - Phone:724-347-3667
Mailing Address - Fax:
Practice Address - Street 1:395 N HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3373
Practice Address - Country:US
Practice Address - Phone:724-347-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004759R213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty