Healthcare Provider Details

I. General information

NPI: 1376759506
Provider Name (Legal Business Name): CHANNEL ISLANDS PROSTHETICS-ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W 5TH ST SUITE A
OXNARD CA
93030-7025
US

IV. Provider business mailing address

4517 MARKET ST SUITE 4
VENTURA CA
93003-7710
US

V. Phone/Fax

Practice location:
  • Phone: 805-486-5531
  • Fax:
Mailing address:
  • Phone: 805-658-1822
  • 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: JOHN S MCATEE
Title or Position: PRES.
Credential: C.P.
Phone: 805-658-1822