MEDICARE: CORE PROSTHETICS LAB, 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	CFM01267	DE
2	335E00000X	Prosthetic/Orthotic Supplier	P1115	DE

General Provider Information

NPI Number	:	1720253305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE PROSTHETICS LAB, INC.

Provider Business Mailing Address
First Line	:	29723 NEW HUB DR STE A
Second Line	:
City	:	SUN CITY
State	:	CA
Zip	:	92586-6537
Country	:	US
Telephone Number	:	951-246-8888
Fax Number	:	951-246-8675

Provider Business Practice Location Address
First Line	:	29723 NEW HUB DR STE A
Second Line	:
City	:	SUN CITY
State	:	CA
Zip	:	92586-6537
Country	:	US
Telephone Number	:	951-246-8888
Fax Number	:	951-246-8675

Authorized Official
Title or Position	:	MANAGER
Name	:	TUTY IRIANTO
Credential	:	CFM01267
Telephone Number	:	951-246-8888

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	11/19/2009

Similar Medicare Providers

1427105121 — RICHARD H EMERY D.C
Practice Location Address:

6537 N COSBY AVE
KANSAS CITY, MO
64151-2380

Practice Phone: 816-587-7711
Practice Fax: 816-587-3460

1558491753 — DR. JARED RYAN LEATH D.C.
Practice Location Address:

6537 N COSBY AVE
KANSAS CITY, MO
64151-2380

Practice Phone: 816-587-7711
Practice Fax: 816-587-3460

1427272046 — EMERY CHIROPRACTIC CLINIC PC
Practice Location Address:

6537 N COSBY AVE
KANSAS CITY, MO
64151-2380

Practice Phone: 816-587-7711
Practice Fax: 816-587-3460

1265650246 — DR. LAWRENCE M WILLIS JR. DDS
Practice Location Address:

6537 E 72ND PL
COMMERCE CITY, CO
80022-1704

Practice Phone: 303-288-7020
Practice Fax:

1992075899 — DONNA GAIL BENJAMIN M.A., MFT
Practice Location Address:

5731 W SLAUSON AVE , SUITE 175
CULVER CITY, CA
90230-6537

Practice Phone: 310-906-7856
Practice Fax:

1447751904 — DAWN PATRICE SMITHEY
Practice Location Address:

5731 W SLAUSON AVE
CULVER CITY, CA
90230-6537

Practice Phone: 310-733-0407
Practice Fax:

Directions to “CORE PROSTHETICS LAB, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.