Organization
JLA SENIOR FOOTCARE HI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY INNOCENZI (OWNER)
(330) 702-0978
Entity
Organization
Contact information
Practice address
1888 KALAKAUA AVE, HONOLULU, HI 96815-1510
(808) 347-0432
Mailing address
4870 S ASPEN CT, CANFIELD, OH 44406-8469
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
PO190
HI
Other
Enumeration date
01/18/2011
Last updated
01/18/2011
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