Basic Information
| Provider Information | |||||||||
| NPI: | 1790866887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARDIZZONE | ||||||||
| FirstName: | REMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 641109 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941641109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157104031 | ||||||||
| FaxNumber: | 4153536401 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 HYDE STREET, SUITE 1100 | ||||||||
| Address2: | CENTER FOR SPORTS MEDICINE | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153536400 | ||||||||
| FaxNumber: | 4153536401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0000X | E4409 | CA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | 213ES0103X | E4409 | CA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00402347 | 01 | MRR | OTHER |