| NPI | 1063458917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE ANGELINE Provider Contract Analyst Iii 714-961-2102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2023-08-04 |