MEDICARE: BLUEBIRD ORTHOTICS AND PROSTHETICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	97948241	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700828944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEBIRD ORTHOTICS AND PROSTHETICS, INC.

Provider Business Mailing Address
First Line	:	4373 VIEWRIDGE AVE STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123
Country	:	US
Telephone Number	:	858-874-6750
Fax Number	:	858-874-6736

Provider Business Practice Location Address
First Line	:	4373 VIEWRIDGE AVE
Second Line	:	STE A
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1619
Country	:	US
Telephone Number	:	858-874-6750
Fax Number	:	858-874-6736

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. KAREN MAYA
Credential	:
Telephone Number	:	858-874-6750

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	11/17/2009

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