Healthcare Provider Details

I. General information

NPI: 1326206392
Provider Name (Legal Business Name): KEITH RYAN SARDO C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E ROMIE LN SUITE 3
SALINAS CA
93901-4026
US

IV. Provider business mailing address

535 E ROMIE LN SUITE 3
SALINAS CA
93901-4026
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-9646
  • Fax: 831-422-3527
Mailing address:
  • Phone: 831-422-9646
  • Fax: 831-422-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO02701
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO02701
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: