MEDICARE: REYZELMAN NEVADA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1215754700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYZELMAN NEVADA PLLC

Provider Business Mailing Address
First Line	:	PO BOX 845038
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-5038
Country	:	US
Telephone Number	:	702-565-6641
Fax Number	:	224-220-9743

Provider Business Practice Location Address
First Line	:	825 N GIBSON RD STE 430
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-1708
Country	:	US
Telephone Number	:	702-565-6641
Fax Number	:	702-565-9249

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	ALEXANDER REYZELMAN
Credential	:	DPM
Telephone Number	:	415-292-0638

Provider Enumeration Date	:	09/25/2024
Last Update Date	:	01/15/2026

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