Healthcare Provider Details

I. General information

NPI: 1013148238
Provider Name (Legal Business Name): PED NEGOTIUM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 PIONEER ST STE F
BREA CA
92821-3712
US

IV. Provider business mailing address

1050 W CENTRAL AVE STE D
BREA CA
92821-2200
US

V. Phone/Fax

Practice location:
  • Phone: 657-229-3079
  • Fax: 714-990-4060
Mailing address:
  • Phone: 714-990-5932
  • Fax: 714-990-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC49909
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberS1389
License Number StateMD

VIII. Authorized Official

Name: GREG WOLFE
Title or Position: PRESIDENT
Credential: C.PED.
Phone: 714-990-5932