Healthcare Provider Details

I. General information

NPI: 1972330280
Provider Name (Legal Business Name): SOCAL FOOT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 1ST AVE
SAN DIEGO CA
92103-4802
US

IV. Provider business mailing address

3424 1ST AVE
SAN DIEGO CA
92103-4802
US

V. Phone/Fax

Practice location:
  • Phone: 619-295-9494
  • Fax: 619-295-9714
Mailing address:
  • Phone: 619-295-9494
  • Fax: 619-295-9714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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