=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114482528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE STOP ORTHOTICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2019
-----------------------------------------------------
Last Update Date | 02/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 S 26TH ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92113-3602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-347-6742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 S 26TH ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92113-3602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-265-4994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANTHONY BELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-265-4994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------