Provider Demographics
NPI:1275196495
Name:OARDE, REISHA (DPM)
Entity Type:Individual
Prefix:DR
First Name:REISHA
Middle Name:
Last Name:OARDE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11730 W ACAPULCO LN
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-6982
Mailing Address - Country:US
Mailing Address - Phone:623-274-3040
Mailing Address - Fax:
Practice Address - Street 1:11730 W ACAPULCO LN
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-6982
Practice Address - Country:US
Practice Address - Phone:623-274-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ211D00000X
AZPOD-001053213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric