Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E4136 | CA |
N | 222Z00000X | Podiatrist | E4136 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E4136 | CA |
NPI | 1023192721 |
---|---|
Provider Name | Dr. Alexander Reyzelman |
First Address | San Francisco, CA 94121-3709 |
Second Address | San Francisco, CA 94115-3443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 28/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E41360 | (05) | CA |
U70377 | (02) |