Organization
JLA SENIOR FOOTCARE FLA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY INNOCENZI DPM (OWNER)
(330) 702-0978
Entity
Organization
Contact information
Practice address
425 N PENINSULA DR STE A, DAYTONA BEACH, FL 32118-4082
(386) 252-4678
Mailing address
4870 S ASPEN CT, CANFIELD, OH 44406-8469
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
PO 3438
FL
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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