Healthcare Provider Details

I. General information

NPI: 1467454777
Provider Name (Legal Business Name): STUART PEDORTHICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17816 CHATSWORTH ST.
GRANADA HILLS CA
91344-5611
US

IV. Provider business mailing address

17816 CHATSWORTH ST.
GRANADA HILLS CA
91344-5611
US

V. Phone/Fax

Practice location:
  • Phone: 818-831-8507
  • Fax: 818-831-8527
Mailing address:
  • Phone: 818-831-8507
  • Fax: 818-831-8527

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: MR. STUART NEAL LUTWAK
Title or Position: PRESIDENT
Credential: C.PED.
Phone: 818-831-8507