Provider Demographics
NPI:1316738214
Name:DESERT MOBILE FOOT CARE LLC
Entity type:Organization
Organization Name:DESERT MOBILE FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDUC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-290-8347
Mailing Address - Street 1:2942 N 24TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7849
Mailing Address - Country:US
Mailing Address - Phone:714-290-8347
Mailing Address - Fax:602-774-0196
Practice Address - Street 1:2942 N 24TH ST STE 114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7849
Practice Address - Country:US
Practice Address - Phone:602-774-0189
Practice Address - Fax:602-774-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty