Healthcare Provider Details

I. General information

NPI: 1952149692
Provider Name (Legal Business Name): MERCY PROSTHETICS & ORTHOTICS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 E 6TH ST STE 4
BEAUMONT CA
92223-2516
US

IV. Provider business mailing address

1390 E 6TH ST STE 4
BEAUMONT CA
92223-2516
US

V. Phone/Fax

Practice location:
  • Phone: 951-966-7661
  • Fax:
Mailing address:
  • Phone: 951-299-8844
  • Fax: 951-717-8991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MENA SALAMA MANOLLY
Title or Position: CERTIFIED PROSTHETIST ORTHTOTIST
Credential: CPO
Phone: 951-299-8844