| NPI | 1295979649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE ANGELINE Provider Contract Analyst Iii 714-961-2102 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: UT 10230905-003-STC) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2024-08-28 |