=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023302015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALDWIN ORTHOTICS & PROSTHETICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2011
-----------------------------------------------------
Last Update Date | 01/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24475 SUNNYMEAD BLVD
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92553-9313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-824-7850
-----------------------------------------------------
Fax | 951-824-7851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24475 SUNNYMEAD BLVD
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92553-9313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-824-7850
-----------------------------------------------------
Fax | 951-824-7851
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. HARLAN L BALDWIN JR.
-----------------------------------------------------
Credential | CERTIFIED ORTHOTISTS
-----------------------------------------------------
Telephone | 951-824-7850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | CO1677
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------