Basic Information
| Provider Information | |||||||||
| NPI: | 1790156768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRANZA | ||||||||
| FirstName: | LEOBARDO | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 N 3RD ST STE 201A | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023144349 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5555 W THUNDERBIRD RD | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028655555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2015 | ||||||||
| LastUpdateDate: | 06/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | POD-000910 | AZ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
No ID Information.