Healthcare Provider Details

I. General information

NPI: 1720782980
Provider Name (Legal Business Name): BAY AREA FOOT CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 BUCKINGHAM WAY STE 330
SAN FRANCISCO CA
94132-1911
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 415-731-6700
  • Fax: 415-759-8637
Mailing address:
  • Phone: 510-581-1484
  • Fax: 510-581-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER REYZELMAN
Title or Position: REGIONAL CHIEF MEDICAL OFFICER
Credential: DPM
Phone: 415-292-0638