=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265440234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERFORMANCE PROSTHETIC ORTHOTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2820 SANTA MONICA BLVD
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-829-2322
-----------------------------------------------------
Fax | 310-315-3634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3256
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90408-3256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-829-2322
-----------------------------------------------------
Fax | 310-315-3634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALBERT FLOYD RAPPOPORT
-----------------------------------------------------
Credential | CP
-----------------------------------------------------
Telephone | 310-829-2322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 43027
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------