Healthcare Provider Details

I. General information

NPI: 1073156337
Provider Name (Legal Business Name): ALEXANDER REYZELMAN, DPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2019
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA ST STE 109
SAN FRANCISCO CA
94110-4420
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 415-285-7711
  • Fax: 415-285-3712
Mailing address:
  • Phone: 415-292-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MS. ROZANA REYZELMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 415-680-0871