Healthcare Provider Details

I. General information

NPI: 1497376156
Provider Name (Legal Business Name): PERFORMANCE MASTERY CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 W 145TH ST
HAWTHORNE CA
90250-8452
US

IV. Provider business mailing address

3711 W 145TH ST
HAWTHORNE CA
90250-8452
US

V. Phone/Fax

Practice location:
  • Phone: 310-910-4347
  • Fax: 212-500-7992
Mailing address:
  • Phone: 310-910-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: PEGGY SUSAN POSTNIKOFF
Title or Position: COO
Credential: B.S.P.E.
Phone: 310-910-4347