Healthcare Provider Details

I. General information

NPI: 1053893347
Provider Name (Legal Business Name): SACRAMENTO FOOT AND ANKLE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 J ST STE 300
SACRAMENTO CA
95819
US

IV. Provider business mailing address

5120 MANZANITA AVE STE 100
CARMICHAEL CA
95608-0590
US

V. Phone/Fax

Practice location:
  • Phone: 916-459-4398
  • Fax: 916-476-5380
Mailing address:
  • Phone: 916-459-4398
  • Fax: 916-965-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ROZANA REYZELMAN
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 415-680-0871