Organization · NPI-2

Agave Foot Specialists, PLLC

Podiatrist, Foot & Ankle Surgery · Phoenix, AZ

NPI number1861508541
StatusActive
Last updated in NPPESFeb 26, 2008

Details

NPI
1861508541
Entity type
Organization (NPI-2)
Legal business name
Agave Foot Specialists, PLLC
Organization subpart
No
Enumeration date
Aug 22, 2006
Last updated
Feb 26, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
213ES0103X Podiatrist, Foot & Ankle Surgery0552AZYes

Practice location

16841 N. 31st Ave.
Ste. 134
Phoenix, AZ 85053-3051

Phone 623-322-5501 · Fax 623-322-8996

Mailing address

16841 N. 31st Ave.
Ste. 134
Phoenix, AZ 85053-3051

Phone 623-322-5501 · Fax 623-322-8996

Authorized official

Heather Ann Couch
Owner/Podiatrist
6233225501

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