1285301010 NPI number — BAY AREA FOOT CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285301010 NPI number — BAY AREA FOOT CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA FOOT CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285301010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20130 LAKE CHABOT RD STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTRO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94546-5340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-581-1484
Provider Business Mailing Address Fax Number:
510-581-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2272 BACON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94520-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-309-5407
Provider Business Practice Location Address Fax Number:
925-891-4655
Provider Enumeration Date:
08/28/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REYZELMAN
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF REGIONAL MEDICAL OFFICER
Authorized Official Telephone Number:
415-292-0638

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)