Provider Demographics
NPI:1053893347
Name:SACRAMENTO FOOT AND ANKLE CENTER, INC.
Entity type:Organization
Organization Name:SACRAMENTO FOOT AND ANKLE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-680-0871
Mailing Address - Street 1:5120 MANZANITA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0590
Mailing Address - Country:US
Mailing Address - Phone:916-459-4398
Mailing Address - Fax:916-965-6715
Practice Address - Street 1:5030 J ST STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-459-4398
Practice Address - Fax:916-476-5380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRAMENTO FOOT AND ANKLE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-04
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty