Healthcare Provider Details

I. General information

NPI: 1144980517
Provider Name (Legal Business Name): ARTISAN FOOT AND ANKLE PODIATRIC SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26691 PLAZA STE 201
MISSION VIEJO CA
92691-8582
US

IV. Provider business mailing address

PO BOX 31502
BELFAST ME
04915-0168
US

V. Phone/Fax

Practice location:
  • Phone: 949-272-0007
  • Fax: 949-272-0006
Mailing address:
  • Phone: 415-645-4525
  • Fax: 510-399-1364

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 TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

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