Provider Demographics
NPI:1184474454
Name:ESSENTIAL FOOT & NAIL CARE LLC
Entity type:Organization
Organization Name:ESSENTIAL FOOT & NAIL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:928-920-5451
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2304
Mailing Address - Country:US
Mailing Address - Phone:928-920-5451
Mailing Address - Fax:
Practice Address - Street 1:11551 S FORTUNA RD STE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7858
Practice Address - Country:US
Practice Address - Phone:928-920-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service