1760989313 NPI number — NORTH BAY PROSTHETICS AND ORTHOTICS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760989313 NPI number — NORTH BAY PROSTHETICS AND ORTHOTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH BAY PROSTHETICS AND ORTHOTICS LLC
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:
6
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:
1760989313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 CHADBOURNE RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94534-9612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-425-5028
Provider Business Mailing Address Fax Number:
707-425-5029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 COYLE AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608-0400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-349-7600
Provider Business Practice Location Address Fax Number:
916-349-7606
Provider Enumeration Date:
04/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BRIGHT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
707-425-5028

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com