Healthcare Provider Details

I. General information

NPI: 1154116499
Provider Name (Legal Business Name): ALBERT RAPPOPORT C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
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 Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: