Healthcare Provider Details

I. General information

NPI: 1720136021
Provider Name (Legal Business Name): HAYWARD FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 W TENNYSON RD NO 3
HAYWARD CA
94544-4454
US

IV. Provider business mailing address

1191 W TENNYSON RD NO 3
HAYWARD CA
94544-4454
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: RITA NYE
Title or Position: BILLING SUPER
Credential:
Phone: 559-783-1181