Healthcare Provider Details

I. General information

NPI: 1891083473
Provider Name (Legal Business Name): DIABLO PROSTHETICS AND ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 NORRIS CANYON RD SUITE 320
SAN RAMON CA
94583-5407
US

IV. Provider business mailing address

PO BOX 5268
PLEASANTON CA
94566-0468
US

V. Phone/Fax

Practice location:
  • Phone: 925-552-5100
  • Fax: 925-552-5109
Mailing address:
  • Phone: 925-484-6400
  • Fax: 925-484-6497

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: MS. KATHLEEN MARIE PELZ
Title or Position: CFO
Credential: CO
Phone: 925-552-5100