Provider Demographics
NPI:1316144835
Name:IXSA'S FOOT AND ANKLE INC
Entity type:Organization
Organization Name:IXSA'S FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IXSA
Authorized Official - Middle Name:TANYA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:952-592-0898
Mailing Address - Street 1:1188 N STATE ROAD 7
Mailing Address - Street 2:APT 103
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6634
Mailing Address - Country:US
Mailing Address - Phone:954-592-0898
Mailing Address - Fax:
Practice Address - Street 1:4343 W FLAGLER ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1586
Practice Address - Country:US
Practice Address - Phone:954-592-0898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65954OtherBCBSFL
FL340653900Medicaid
FL65954OtherBCBSFL