Healthcare Provider Details

I. General information

NPI: 1578659645
Provider Name (Legal Business Name): RIVERSIDE ARTIFICIAL LIMB & BRACE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 BROCKTON AVE
RIVERSIDE CA
92501-3440
US

IV. Provider business mailing address

4013 BROCKTON AVE
RIVERSIDE CA
92501-3440
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-3011
  • Fax: 951-781-4751
Mailing address:
  • Phone: 951-781-3011
  • Fax: 951-781-4751

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: MR. THOMAS A BARTCZAK
Title or Position: PRESIDENT
Credential: CERTIFIED ORTHOTIST
Phone: 951-781-3011