Healthcare Provider Details

I. General information

NPI: 1104173053
Provider Name (Legal Business Name): MOBILE PROSTHETICS AND ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33374 DOWE AVE
UNION CITY CA
94587-2034
US

IV. Provider business mailing address

33374 DOWE AVE
UNION CITY CA
94587-2034
US

V. Phone/Fax

Practice location:
  • Phone: 510-282-6898
  • Fax:
Mailing address:
  • Phone: 510-282-6898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO004391
License Number StateCA

VIII. Authorized Official

Name: RICHARD ALI
Title or Position: CERTIFIED ORTHOTIST
Credential: C.O
Phone: 510-282-6898