Healthcare Provider Details

I. General information

NPI: 1003804071
Provider Name (Legal Business Name): R AND J PROSTHETIC APPLIANCE CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 E MAIN ST
VENTURA CA
93003-2603
US

IV. Provider business mailing address

2407 E MAIN ST
VENTURA CA
93003-2603
US

V. Phone/Fax

Practice location:
  • Phone: 805-643-4063
  • Fax: 805-643-5876
Mailing address:
  • Phone: 805-643-4063
  • Fax: 805-643-5876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. LOGAN M NEWTON
Title or Position: PRESIDENT/OWNER
Credential: C.P.O.
Phone: 805-643-4063