Healthcare Provider Details

I. General information

NPI: 1073569554
Provider Name (Legal Business Name): PROSTHETIC & ORTHOTIC GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 MYRTLE AVE STE 101
SIGNAL HILL CA
90755
US

IV. Provider business mailing address

2669 MYRTLE AVE STE 101
SIGNAL HILL CA
90755-2746
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-6445
  • Fax: 562-424-3122
Mailing address:
  • Phone: 562-595-6445
  • Fax: 562-424-3122

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. GLENN MATSUSHIMA
Title or Position: PRESIDENT
Credential:
Phone: 562-595-6445