Healthcare Provider Details

I. General information

NPI: 1649514845
Provider Name (Legal Business Name): DYNAMICS ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16077 KAMANA RD SUITE 100
APPLE VALLEY CA
92307-1331
US

IV. Provider business mailing address

1830 W OLYMPIC BLVD SUITE 123
LOS ANGELES CA
90006-3734
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-6444
  • Fax: 760-242-6446
Mailing address:
  • Phone: 213-383-9212
  • Fax: 213-383-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER J SEAN
Title or Position: CERTIFIED PROSTHETIST ORTHOTIST
Credential: CPO
Phone: 213-383-9212