Healthcare Provider Details

I. General information

NPI: 1528071099
Provider Name (Legal Business Name): LARRY LAX CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ARYEH LAX CPO

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD BUILDING 304 PROSTHETICS
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

11301 WILSHIRE BLVD BUILDING 304 PROSTHETICS
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-3875
  • Fax:
Mailing address:
  • Phone: 310-268-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO879
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: