Provider Demographics
NPI:1083762959
Name:HAYWARD FOOT & ANKLE CENTER
Entity Type:Organization
Organization Name:HAYWARD FOOT & ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTAGHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-732-1566
Mailing Address - Street 1:1191 W. TENNYSON RD. STE 3
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544
Mailing Address - Country:US
Mailing Address - Phone:510-732-1566
Mailing Address - Fax:510-732-1515
Practice Address - Street 1:1191 W. TENNYSON RD. STE 3
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544
Practice Address - Country:US
Practice Address - Phone:510-732-1566
Practice Address - Fax:510-732-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty