Healthcare Provider Details

I. General information

NPI: 1497731533
Provider Name (Legal Business Name): DJO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5919 SEA OTTER PL STE 200
CARLSBAD CA
92010-6750
US

IV. Provider business mailing address

2900 LAKE VISTA DR STE 200
LEWISVILLE TX
75067-3889
US

V. Phone/Fax

Practice location:
  • Phone: 972-956-4323
  • Fax:
Mailing address:
  • Phone: 866-356-7846
  • Fax: 844-277-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ANDRES MORENO III
Title or Position: PRESIDENT
Credential:
Phone: 800-321-9549