Healthcare Provider Details

I. General information

NPI: 1467118786
Provider Name (Legal Business Name): KIRSTEN GEORGE CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD STE 310
LOS ANGELES CA
90017-3913
US

IV. Provider business mailing address

1127 WILSHIRE BLVD STE 310
LOS ANGELES CA
90017-3913
US

V. Phone/Fax

Practice location:
  • Phone: 213-250-7850
  • Fax:
Mailing address:
  • Phone: 213-250-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO04812
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO04812
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: