Healthcare Provider Details

I. General information

NPI: 1790866887
Provider Name (Legal Business Name): REMY ARDIZZONE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HYDE STREET, SUITE 1100 CENTER FOR SPORTS MEDICINE
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

PO BOX 641109
SAN FRANCISCO CA
94164-1109
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-6400
  • Fax: 415-353-6401
Mailing address:
  • Phone: 415-710-4031
  • Fax: 415-353-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE4409
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: