Basic Information
| Provider Information | |||||||||
| NPI: | 1669608188 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FLAHERTY FOOTCARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2914 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932915731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596272849 | ||||||||
| FaxNumber: | 5596279772 | ||||||||
| Practice Location | |||||||||
| Address1: | 2914 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932915731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596272849 | ||||||||
| FaxNumber: | 5596279772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 06/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | FLAHERTY | ||||||||
| AuthorizedOfficialFirstName: | LOREEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PODIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 5596272849 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.P.M. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | E29520 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.