Marin Advanced Wound Center PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

G59522 Issued in CA

Legal business name

MARIN ADVANCED WOUND CENTER PC

Practice address

165 Rowland Way Ste 208
Novato, CA 94945-5055

Phone

(415) 680-0871

Fax

(800) 808-1779

NPI assigned

Jun 10, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alexander Reyzelman, DPMNPI 1023192721

Title

Authorized Official

Phone

(925) 336-6062

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Alexander Reyzelman, DPM, Inc.

  • Primary Podiatric Medicine Podiatrist
  • San Francisco, CA
  • NPI 1780166074

  Member Of

  NPD member

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24064/brand/1/csg/1/fhir/r4

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexander Reyzelman, DPM

  • Foot Surgery Podiatrist
  • San Francisco, CA
  • NPI 1023192721
  Medicare reassignment Authorized official
• Anthony K Gordon, MD

  • Diagnostic Radiology Physician
  • Novato, CA
  • NPI 1912968041
  Medicare reassignment
• Mher Vartivarian, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • San Francisco, CA
  • NPI 1801117874
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1538652003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 ROWLAND WAY STE 208",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949455055",
            "telephone_number": "415-680-0871",
            "fax_number": "800-808-1779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 ROWLAND WAY STE 208",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949455055",
            "telephone_number": "415-680-0871",
            "fax_number": "800-808-1779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN ADVANCED WOUND CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-10",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "REYZELMAN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "925-336-6062",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "G59522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Gabrielle Mangion, MA
• Connie Mann, MFT
• Upenda Manning
• Tania M. Mantua, O.D.
• Maria Serrano Dental Corp.
• Marin Community Clinic
• Marin Community Clinic
• Marin Community Clinic
• Marin Community Clinic
• Marin Cosmetic Surgery Center

• Clinic/Center in Novato, CA
• Providers in Novato, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.