Healthcare Provider Details

I. General information

NPI: 1215754700
Provider Name (Legal Business Name): REYZELMAN NEVADA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N GIBSON RD STE 430
HENDERSON NV
89011-1708
US

IV. Provider business mailing address

PO BOX 845038
LOS ANGELES CA
90084-5038
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-6641
  • Fax: 702-565-9249
Mailing address:
  • Phone: 702-565-6641
  • Fax: 224-220-9743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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