| NPI | 1124260252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE ANGELINE Provider Contract Analyst Iii 714-961-2102 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: KY CPO1570/KY) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2024-02-22 |