Healthcare Provider Details

I. General information

NPI: 1932365673
Provider Name (Legal Business Name): HEMET PROSTHETIC & ORTHOTIC GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41785 ENTERPRISE CIR S #E
TEMECULA CA
92590-9804
US

IV. Provider business mailing address

1133 E FLORIDA AVE
HEMET CA
92543-4512
US

V. Phone/Fax

Practice location:
  • Phone: 951-296-9677
  • Fax: 951-296-9681
Mailing address:
  • Phone: 951-766-4297
  • Fax: 951-766-4299

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. WAYNE ALLEN KAUFMAN
Title or Position: PRESIDENT
Credential: C.P.O.
Phone: 951-766-4297