Organization
PODORTIS CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS CARBAJAL LPED, LOF,CPOA (PRESIDENT/OWNER)
(305) 446-2995
Entity
Organization
Contact information
Practice address
5841 SW 8TH ST, WEST MIAMI, FL 33144-5035
(305) 446-2995
(305) 446-2996
Mailing address
5841 SW 8TH ST, WEST MIAMI, FL 33144-5035
(305) 446-2995
(305) 446-2996
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
OFA275
FL
335E00000X
Prosthetic/Orthotic Supplier
ORF235
FL
335E00000X
Prosthetic/Orthotic Supplier
Primary
PED160
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002351800
—
FL
01
—
20636
MEDICA HEALTH PLANS
—
Enumeration date
01/14/2009
Last updated
10/30/2012
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