| NPI | 1346667763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE ANGELINE Provider Contract Analyst Iii 714-961-2102 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: GA 28) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2024-11-07 |