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General NPI Number Information
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NPI Number | 1164013561
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ORTHOPEDIC SYSTEMS OF SACRAMENTO, LLC
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Dates
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Enumeration Date | 01/28/2021
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 5601 66TH AVE STE B
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City | SACRAMENTO
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State | CA
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Zip | 95823-2648
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Country | US
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Telephone | 916-331-3537
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Fax | 916-331-3587
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Provider Business Mailing Address
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Address Line | 5049 COLLEGE OAK DR STE F
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City | SACRAMENTO
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State | CA
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Zip | 95841-4630
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Country | US
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Telephone | 916-331-3537
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Fax | 916-331-3587
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Authorized Official
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Title or Position | OWNER
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Name | KIM TABLADA
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Credential | C.P.O.
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Telephone | 916-331-3537
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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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