Healthcare Provider Details

I. General information

NPI: 1073231049
Provider Name (Legal Business Name): BAY AREA FOOT CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 LOS GATOS BLVD STE 4
LOS GATOS CA
95032-2028
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 408-358-6234
  • Fax: 408-358-3389
Mailing address:
  • Phone: 510-581-1484
  • Fax: 510-581-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROZANA REYZELMAN
Title or Position: DIRECTOR OF OPERATION
Credential:
Phone: 415-680-0871