Provider Demographics
NPI:1790866887
Name:ARDIZZONE, REMY (DPM)
Entity Type:Individual
Prefix:DR
First Name:REMY
Middle Name:
Last Name:ARDIZZONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641109
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94164-1109
Mailing Address - Country:US
Mailing Address - Phone:415-710-4031
Mailing Address - Fax:415-353-6401
Practice Address - Street 1:900 HYDE STREET, SUITE 1100
Practice Address - Street 2:CENTER FOR SPORTS MEDICINE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-353-6400
Practice Address - Fax:415-353-6401
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4409213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00402347OtherMRR
U97666Medicare UPIN
000E44090Medicare PIN
000E44091Medicare PIN