Healthcare Provider Details

I. General information

NPI: 1215958368
Provider Name (Legal Business Name): WEST COAST ORTHOTIC & PROSTHETIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 COFFEE RD STE 3
MODESTO CA
95355
US

IV. Provider business mailing address

1705 COFFEE RD STE 3
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-550-0100
  • Fax: 209-550-0117
Mailing address:
  • Phone: 209-550-0100
  • Fax: 209-550-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID R VERA SR.
Title or Position: PRES
Credential: CO
Phone: 209-550-0100