Healthcare Provider Details

I. General information

NPI: 1760989313
Provider Name (Legal Business Name): NORTH BAY PROSTHETICS AND ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 COYLE AVE STE B
CARMICHAEL CA
95608-0400
US

IV. Provider business mailing address

450 CHADBOURNE RD STE B
FAIRFIELD CA
94534-9612
US

V. Phone/Fax

Practice location:
  • Phone: 916-349-7600
  • Fax: 916-349-7606
Mailing address:
  • Phone: 707-425-5028
  • Fax: 707-425-5029

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: MICHAEL JOSEPH BRIGHT
Title or Position: CEO
Credential:
Phone: 707-425-5028