Healthcare Provider Details

I. General information

NPI: 1780166074
Provider Name (Legal Business Name): ALEXANDER REYZELMAN, DPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 08/28/2021
Certification Date: 08/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 CLEMENT ST
SAN FRANCISCO CA
94118-1031
US

IV. Provider business mailing address

2299 POST ST STE 205
SAN FRANCISCO CA
94115-3473
US

V. Phone/Fax

Practice location:
  • Phone: 415-387-5556
  • Fax: 415-387-2424
Mailing address:
  • Phone: 415-292-0638
  • Fax: 415-292-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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