Healthcare Provider Details

I. General information

NPI: 1083762959
Provider Name (Legal Business Name): HAYWARD FOOT & ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 W. TENNYSON RD. STE 3
HAYWARD CA
94544
US

IV. Provider business mailing address

1191 W. TENNYSON RD. STE 3
HAYWARD CA
94544
US

V. Phone/Fax

Practice location:
  • Phone: 510-732-1566
  • Fax: 510-732-1515
Mailing address:
  • Phone: 510-732-1566
  • Fax: 510-732-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BITA MOSTAGHIMI
Title or Position: OWNER
Credential: D.P.M.
Phone: 510-732-1566