1285965392 NPI number — AMERICAN ORTHOTICS & PROSTHETICS

Table of content: (NPI 1285965392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285965392 NPI number — AMERICAN ORTHOTICS & PROSTHETICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN ORTHOTICS & PROSTHETICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285965392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2786
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92516-2786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-473-9308
Provider Business Mailing Address Fax Number:
951-367-6702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 WESTERN AVE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92411-1356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-473-9308
Provider Business Practice Location Address Fax Number:
951-367-7789
Provider Enumeration Date:
01/29/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SULIS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
CPO, OWNER
Authorized Official Telephone Number:
951-367-6702

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: CPO02649 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: XA0029550 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CMS168487 . This is a "CALIFORNIA CHILDRENS SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".