Healthcare Provider Details

I. General information

NPI: 1679283261
Provider Name (Legal Business Name): BAY AREA FOOT CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 MANZANITA AVE STE 100
CARMICHAEL CA
95608-0590
US

IV. Provider business mailing address

20130 LAKE CHABOT RD STE 202
CASTRO VALLEY CA
94546-5340
US

V. Phone/Fax

Practice location:
  • Phone: 916-459-4398
  • Fax: 916-965-6715
Mailing address:
  • Phone: 510-581-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER REYZELMAN
Title or Position: CHIEF REGIONAL MEDICAL OFFICER
Credential: DPM
Phone: 415-292-0638