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General NPI Number Information
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NPI Number | 1245534510
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Entity Type | Organization
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Legal Business Name | AESTHETIC PROSTHETICS, INC.
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Dates
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Enumeration Date | 12/30/2010
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Last Update Date | 12/30/2010
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Provider Practice Location Address
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Address Line | 1095 N ALLEN AVE
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City | PASADENA
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State | CA
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Zip | 91104-3204
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Country | US
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Telephone | 626-345-0050
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Fax | 626-345-0052
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Provider Business Mailing Address
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Address Line | 1095 N ALLEN AVE
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City | PASADENA
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State | CA
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Zip | 91104-3204
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Country | US
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Telephone | 626-345-0050
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Fax | 626-345-0052
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEFAN JOHANNES KNAUSS
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Credential | MAMS, CPO
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Telephone | 626-345-0050
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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 | CPO01364
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License Number State | VA
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