Provider Demographics
NPI:1093500910
Name:SOCAL FOOT CARE PC
Entity type:Organization
Organization Name:SOCAL FOOT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCMO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:REYZELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-292-0638
Mailing Address - Street 1:PO BOX 34869
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0626
Mailing Address - Country:US
Mailing Address - Phone:858-450-9218
Mailing Address - Fax:858-450-3296
Practice Address - Street 1:28078 BAXTER RD STE 424
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1404
Practice Address - Country:US
Practice Address - Phone:951-679-1020
Practice Address - Fax:951-679-5844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCAL FOOT CARE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty