Healthcare Provider Details

I. General information

NPI: 1629350178
Provider Name (Legal Business Name): STANCE PROSTHETICS & ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2011
Last Update Date: 10/02/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E 17TH ST STE N354
SANTA ANA CA
92701-2269
US

IV. Provider business mailing address

1125 E 17TH ST STE N354
SANTA ANA CA
92701-2269
US

V. Phone/Fax

Practice location:
  • Phone: 714-852-3756
  • Fax: 714-852-3856
Mailing address:
  • Phone: 714-852-3756
  • Fax: 714-852-3856

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: KENNETH TEMEKI
Title or Position: MEMBER/OWNER LLC
Credential:
Phone: 714-852-3756