| NPI | 1639764582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE ANGELINE Reg Compliance Specialist Iv 714-961-2102 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 222Z00000X Orthotist |
| 224P00000X Prosthetist | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2022-12-02 |