Healthcare Provider Details

I. General information

NPI: 1427463637
Provider Name (Legal Business Name): ESCALATE PROSTHETIC ORTHOTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2982 MCDONALD LN
CORONA CA
92881-8212
US

IV. Provider business mailing address

2982 MCDONALD LN
CORONA CA
92881-8212
US

V. Phone/Fax

Practice location:
  • Phone: 310-480-8760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. PAM MITRA
Title or Position: PRESIDENT
Credential:
Phone: 310-480-8760