MEDICARE: BAY AREA FOOT CARE, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	213E00000X	Podiatrist
3	163WW0000X	Wound Care Registered Nurse
4	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1346928009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA FOOT CARE, INC

Provider Business Mailing Address
First Line	:	20130 LAKE CHABOT RD STE 202
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5340
Country	:	US
Telephone Number	:	510-581-1484
Fax Number	:	510-581-7779

Provider Business Practice Location Address
First Line	:	4722 QUAIL LAKES DR STE A
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-5256
Country	:	US
Telephone Number	:	209-476-0675
Fax Number	:	209-476-9389

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

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	07/01/2024

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