Healthcare Provider Details

I. General information

NPI: 1003139866
Provider Name (Legal Business Name): WES SPHAR PEDORTHIC SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/O 2682 LA RINCONADA PLACE
REDDING CA
96002-3708
US

IV. Provider business mailing address

C/O 2682 LA RINCONADA PLACE
REDDING CA
96002-3708
US

V. Phone/Fax

Practice location:
  • Phone: 530-224-9420
  • Fax: 530-224-1095
Mailing address:
  • Phone: 530-224-9420
  • Fax: 530-224-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1126
License Number StateCA

VIII. Authorized Official

Name: JOSELYN SPHAR
Title or Position: BILLER
Credential:
Phone: 530-224-9420