Provider Demographics
NPI:1720276462
Name:FOTF CORP
Entity Type:Organization
Organization Name:FOTF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTRON
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-978-4693
Mailing Address - Street 1:6427 NW 18 AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-5056
Mailing Address - Country:US
Mailing Address - Phone:305-235-7926
Mailing Address - Fax:305-235-7952
Practice Address - Street 1:18240 SW 110TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5056
Practice Address - Country:US
Practice Address - Phone:305-235-7926
Practice Address - Fax:305-235-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare