Healthcare Provider Details

I. General information

NPI: 1558051755
Provider Name (Legal Business Name): SOCAL FOOT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N EL CAMINO REAL STE 201
ENCINITAS CA
92024-1335
US

IV. Provider business mailing address

PO BOX 34869
BELFAST ME
04915-0626
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-8667
  • Fax: 760-436-2292
Mailing address:
  • Phone: 858-450-9218
  • Fax: 858-450-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER REYZELMAN
Title or Position: RCMO
Credential: DPM
Phone: 415-292-0638