Healthcare Provider Details

I. General information

NPI: 1720259872
Provider Name (Legal Business Name): MICHAEL R. WARD C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31213 TEMECULA PKWY SUITE 105
TEMECULA CA
92592-6827
US

IV. Provider business mailing address

7720 CARDINAL CT
SAN DIEGO CA
92123-3333
US

V. Phone/Fax

Practice location:
  • Phone: 951-506-7850
  • Fax: 951-506-7863
Mailing address:
  • Phone: 858-292-7449
  • Fax: 858-292-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: