Organization
RIO GRANDE FOOT & ANKLE SPECIALISTS LLC
Active
Parent organization
RIO GRANDE FOOT & ANKLE SPECIALISTS LLC
Other names
Rio Grande Foot & Ankle Specialists LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
RIO GRANDE FOOT & ANKLE SPECIALISTS LLC
Authorized official
MICHELLE ELIZABETH DEITHLOFF (DPM/OWNER)
(505) 395-9575
Entity
Organization
Contact information
Practice address
2019 GALISTEO ST STE K-2, SANTA FE, NM 87505-2143
(505) 395-9575
(877) 540-1253
Mailing address
PO BOX 540610, N SALT LAKE, UT 84054-0610
(801) 505-0821
(801) 505-0803
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
POD401
MEDICAL LICENSE
NM
Enumeration date
07/23/2020
Last updated
06/13/2022
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