Healthcare Provider Details

I. General information

NPI: 1568537637
Provider Name (Legal Business Name): INLAND ARTIFICIAL LIMB & BRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41707 WINCHESTER RD STE 102
TEMECULA CA
92590
US

IV. Provider business mailing address

680 PARKRIDGE AVE
NORCO CA
92860-3124
US

V. Phone/Fax

Practice location:
  • Phone: 951-296-1894
  • Fax: 951-296-1896
Mailing address:
  • Phone: 951-734-1835
  • Fax: 951-734-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number015448
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. GUY SAVIDAN
Title or Position: PRESIDENT
Credential: C.P.
Phone: 951-734-1835