Healthcare Provider Details

I. General information

NPI: 1104856806
Provider Name (Legal Business Name): AMERICAN ORTHOTICS & PROSTHETICS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3714 TIBBETTS ST SUITE 104
RIVERSIDE CA
92506-2661
US

IV. Provider business mailing address

PO BOX 2786
RIVERSIDE CA
92516-2786
US

V. Phone/Fax

Practice location:
  • Phone: 951-367-6702
  • Fax: 951-367-7789
Mailing address:
  • Phone: 951-367-6702
  • Fax: 951-367-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DAVID S. SULIS
Title or Position: PROSTHETIST ORTHOTIST (OWNER)
Credential: CPO
Phone: 951-367-6702