Healthcare Provider Details

I. General information

NPI: 1245113968
Provider Name (Legal Business Name): PROSTHETICS & ORTHOTICS SPECIALIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 BRISTOL ST STE 110
COSTA MESA CA
92626-5985
US

IV. Provider business mailing address

56 SEQUOIA TREE LN
IRVINE CA
92612-2227
US

V. Phone/Fax

Practice location:
  • Phone: 949-455-0404
  • Fax:
Mailing address:
  • Phone: 949-412-2633
  • Fax:

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: ELHAM SHARIF
Title or Position: OWNER, CEO
Credential: MSPO, CPO, C.PED
Phone: 949-412-2633