Healthcare Provider Details

I. General information

NPI: 1447080882
Provider Name (Legal Business Name): ARTISAN FOOT AND ANKLE PODIATRIC SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 TOWNE CENTRE DR STE 204
FOOTHILL RANCH CA
92610-2842
US

IV. Provider business mailing address

PO BOX 843263
LOS ANGELES CA
90084-3263
US

V. Phone/Fax

Practice location:
  • Phone: 949-272-0007
  • Fax: 949-272-0006
Mailing address:
  • Phone: 847-627-4920
  • Fax: 224-220-9743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

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