Organization
JLA SENIOR FOOTCARE NM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY INNOCENZI (OWNER)
(330) 702-0978
Entity
Organization
Contact information
Practice address
1600 W AVE I, LOVINGTON, NM 88260-5002
(575) 396-5212
Mailing address
4870 S ASPEN CT, CANFIELD, OH 44406-8469
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
331
NM
Other
Enumeration date
09/01/2010
Last updated
09/01/2010
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