Healthcare Provider Details

I. General information

NPI: 1508397514
Provider Name (Legal Business Name): VITO'S PEDORTHIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 E ROWLAND ST SUITE 2
COVINA CA
91723-3065
US

IV. Provider business mailing address

153 E ROWLAND ST
COVINA CA
91723-3049
US

V. Phone/Fax

Practice location:
  • Phone: 626-858-9460
  • Fax: 626-858-9767
Mailing address:
  • Phone: 626-858-9460
  • Fax: 626-858-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State

VIII. Authorized Official

Name: BEN DJABOURIAN
Title or Position: PEDORTHIST/OWNER
Credential: C.PED
Phone: 626-858-9460