MEDICARE: SOCAL FOOT CARE PC

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	:	1972330280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOCAL FOOT CARE PC

Provider Business Mailing Address
First Line	:	3424 1ST AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4802
Country	:	US
Telephone Number	:	619-295-9494
Fax Number	:	619-295-9714

Provider Business Practice Location Address
First Line	:	3424 1ST AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4802
Country	:	US
Telephone Number	:	619-295-9494
Fax Number	:	619-295-9714

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

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	09/19/2024

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Directions to “SOCAL FOOT CARE PC ” Practice Location

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