=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538163878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPROS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 07/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 SANTA MONICA BLVD STE 104E
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-828-7485
-----------------------------------------------------
Fax | 310-828-7067
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2021 SANTA MONICA BLVD STE 104E
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-828-7485
-----------------------------------------------------
Fax | 310-828-7067
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. JOEL L BERNKNOPF
-----------------------------------------------------
Credential | C.O.
-----------------------------------------------------
Telephone | 310-828-7485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------