=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639046659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAS VEGAS FOOT AND ANKLE CENTERS LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2025
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10561 JEFFREYS ST STE 110
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-4267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-456-3668
-----------------------------------------------------
Fax | 702-456-6688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2649 W HORIZON RIDGE PKWY STE 100
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89052-4801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-565-6641
-----------------------------------------------------
Fax | 702-565-9249
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CMO
-----------------------------------------------------
Name | ALEXANDER REYZELMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-292-0638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------