Provider Demographics
NPI:1801013149
Name:TOE-TAL FAMILY FOOTCARE ASSOCIATES
Entity Type:Organization
Organization Name:TOE-TAL FAMILY FOOTCARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-524-0367
Mailing Address - Street 1:2604 EL CAMINO REAL
Mailing Address - Street 2:STE B #311
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1205
Mailing Address - Country:US
Mailing Address - Phone:702-524-0367
Mailing Address - Fax:760-943-8816
Practice Address - Street 1:1512 GREEN OAK RD
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8740
Practice Address - Country:US
Practice Address - Phone:702-524-0367
Practice Address - Fax:760-943-8816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV9101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0999550001Medicare NSC
NVV32868Medicare PIN