Healthcare Provider Details

I. General information

NPI: 1457445280
Provider Name (Legal Business Name): INLINE ORTHOTIC & PROSTHETIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 JACKSON DR STE 110
LA MESA CA
91942-6002
US

IV. Provider business mailing address

5360 JACKSON DR STE 110
LA MESA CA
91942-6002
US

V. Phone/Fax

Practice location:
  • Phone: 619-667-7000
  • Fax: 619-667-4315
Mailing address:
  • Phone: 619-667-7000
  • Fax: 619-667-4315

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. HERBERT JOSEPH BARRACK
Title or Position: CEO/CERTIFIED PROSTHETIST/ORTHOTIST
Credential: C.P.O.
Phone: 619-667-7000