Healthcare Provider Details

I. General information

NPI: 1366484016
Provider Name (Legal Business Name): MISSION PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/03/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 N TUSTIN ST
ORANGE CA
92867
US

IV. Provider business mailing address

960 N TUSTIN ST # 392
ORANGE CA
92867-5956
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-3222
  • Fax:
Mailing address:
  • Phone: 949-310-4788
  • Fax: 714-633-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateCA

VIII. Authorized Official

Name: NANCY WANG
Title or Position: MANAGER
Credential:
Phone: 714-633-3222