Healthcare Provider Details

I. General information

NPI: 1538163878
Provider Name (Legal Business Name): ORTHOPROS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SANTA MONICA BLVD STE 104E
SANTA MONICA CA
90404-2208
US

IV. Provider business mailing address

2021 SANTA MONICA BLVD STE 104E
SANTA MONICA CA
90404-2208
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-7485
  • Fax: 310-828-7067
Mailing address:
  • Phone: 310-828-7485
  • Fax: 310-828-7067

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: MR. JOEL L BERNKNOPF
Title or Position: VICE PRESIDENT
Credential: C.O.
Phone: 310-828-7485