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General NPI Number Information
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NPI Number | 1205187218
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Entity Type | Organization
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Legal Business Name | APEX PROSTHETICS INSTITUTE OF SAN DIEGO
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 3585 5TH AVE SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92103-5081
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Country | US
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Telephone | 619-501-5383
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Fax | 619-501-5390
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Provider Business Mailing Address
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Address Line | 3585 5TH AVE SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92103-5081
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Country | US
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Telephone | 619-501-5383
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Fax | 619-501-5390
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Authorized Official
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Title or Position | PROSTHETIST
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Name | DR. SHAWN DAVID MOCK
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Credential | C.P, D.C
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Telephone | 619-501-5383
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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 | CP003901
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License Number State | CA
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