Healthcare Provider Details

I. General information

NPI: 1245534510
Provider Name (Legal Business Name): AESTHETIC PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 N ALLEN AVE
PASADENA CA
91104-3204
US

IV. Provider business mailing address

1095 N ALLEN AVE
PASADENA CA
91104-3204
US

V. Phone/Fax

Practice location:
  • Phone: 626-345-0050
  • Fax: 626-345-0052
Mailing address:
  • Phone: 626-345-0050
  • Fax: 626-345-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCPO01364
License Number StateVA

VIII. Authorized Official

Name: MR. STEFAN JOHANNES KNAUSS
Title or Position: PRESIDENT
Credential: MAMS, CPO
Phone: 626-345-0050