1902087802 NPI number — ANAHEIM ORTHOTICS AND ORTHOPEDIC APPLIANCES

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 1902087802 NPI number — ANAHEIM ORTHOTICS AND ORTHOPEDIC APPLIANCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANAHEIM ORTHOTICS AND ORTHOPEDIC APPLIANCES
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:
1902087802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1177 N KRAEMER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92806-1917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-632-3263
Provider Business Mailing Address Fax Number:
714-632-3318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1177 N KRAEMER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92806-1917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-632-3263
Provider Business Practice Location Address Fax Number:
714-632-3318
Provider Enumeration Date:
11/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARTCZAK
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER CERTIFIED PEDORTHIST
Authorized Official Telephone Number:
714-632-3263

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , 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)





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