Organization
JLA SENIOR FOOTCARE OH PA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY E INNOCENZI DPM (OWNER)
(330) 702-0978
Entity
Organization
Contact information
Practice address
6715 TIPPECANOE RD BLDG F, CANFIELD, OH 44406-8180
(330) 702-0978
(330) 286-3202
Mailing address
4870 S ASPEN CT, CANFIELD, OH 44406-8469
(330) 702-0978
(330) 286-3202
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36003012
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3095896
—
OH
Enumeration date
08/30/2010
Last updated
06/24/2011
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