Provider Demographics
NPI:1144770256
Name:SACRAMENTO FOOT AND ANKLE CENTER, INC
Entity Type:Organization
Organization Name:SACRAMENTO FOOT AND ANKLE CENTER, INC
Other - Org Name:SACRAMENTO FOOT AND ANKLE CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
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
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0558
Mailing Address - Country:US
Mailing Address - Phone:916-459-4398
Mailing Address - Fax:916-965-6715
Practice Address - Street 1:5120 MANZANITA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-459-4398
Practice Address - Fax:916-965-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGNB32016-02911213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty