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General NPI Number Information
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NPI Number | 1124738257
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Entity Type | Organization
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Legal Business Name | ABLE ORTHO CLINIC INC
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 1411 RIMPAU AVE STE 110
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City | CORONA
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State | CA
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Zip | 92879-2681
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Country | US
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Telephone | 951-531-8035
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Fax | 951-929-5033
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Provider Business Mailing Address
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Address Line | 2982 MCDONALD LN
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City | CORONA
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State | CA
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Zip | 92881-8212
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Country | US
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Telephone | 310-561-2087
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Fax |
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Authorized Official
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Title or Position | OWNER / CEO
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Name | MR. AVI MITRA
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Credential |
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Telephone | 310-561-2087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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