Healthcare Provider Details

I. General information

NPI: 1720573496
Provider Name (Legal Business Name): HANGER PROSTHETICS & ORTHOTICS WEST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 02/25/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E WILLOW ST
LONG BEACH CA
90806-3115
US

IV. Provider business mailing address

P O BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 562-206-8032
  • Fax: 562-217-4507
Mailing address:
  • Phone:
  • 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: GRACE ANGELINE
Title or Position: REG COMPLIANCE SPECIALIST IV
Credential:
Phone: 714-961-2102