Healthcare Provider Details

I. General information

NPI: 1386478592
Provider Name (Legal Business Name): BAY AREA FOOT CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 VALE RD STE 12
SAN PABLO CA
94806-3848
US

IV. Provider business mailing address

PO BOX 25576
BELFAST ME
04915-2006
US

V. Phone/Fax

Practice location:
  • Phone: 510-232-0892
  • Fax: 510-234-5951
Mailing address:
  • Phone: 415-645-4525
  • Fax: 510-399-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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: RCMO
Credential: DPM
Phone: 415-292-0638