Healthcare Provider Details

I. General information

NPI: 1710175757
Provider Name (Legal Business Name): JAMES R WELCH II CP, CPED, CFO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 PUTNAM BLVD
PLEASANT HILL CA
94523-4650
US

IV. Provider business mailing address

3161 PUTNAM BLVD
PLEASANT HILL CA
94523-4650
US

V. Phone/Fax

Practice location:
  • Phone: 925-943-1119
  • Fax: 925-943-2493
Mailing address:
  • Phone: 925-943-1119
  • Fax: 925-943-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: