Healthcare Provider Details

I. General information

NPI: 1265440234
Provider Name (Legal Business Name): PERFORMANCE PROSTHETIC ORTHOTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 SANTA MONICA BLVD
SANTA MONICA CA
90404-2410
US

IV. Provider business mailing address

PO BOX 3256
SANTA MONICA CA
90408-3256
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-2322
  • Fax: 310-315-3634
Mailing address:
  • Phone: 310-829-2322
  • Fax: 310-315-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number43027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ALBERT FLOYD RAPPOPORT
Title or Position: PRESIDENT
Credential: CP
Phone: 310-829-2322