Healthcare Provider Details

I. General information

NPI: 1992008387
Provider Name (Legal Business Name): CAROL LEWIS STOLPE, BCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N BEDFORD DR SUITE 411
BEVERLY HILLS CA
90210-4321
US

IV. Provider business mailing address

435 N BEDFORD DR SUITE 411
BEVERLY HILLS CA
90210-4321
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-8801
  • Fax: 310-271-6189
Mailing address:
  • Phone: 310-271-8801
  • Fax: 310-271-6189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberM0096453
License Number StateCA

VIII. Authorized Official

Name: MS. CAROLE STOLPE
Title or Position: OWNER
Credential: BCO,
Phone: 310-271-8801