=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578566816
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNNY HILLS ORTHOPEDIC SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2005
-----------------------------------------------------
Last Update Date | 01/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 332 E COMMONWEALTH AVE
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92832-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-738-4769
-----------------------------------------------------
Fax | 714-871-4816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 332 E COMMONWEALTH AVE
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92832-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-738-4769
-----------------------------------------------------
Fax | 714-871-4816
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RANDALL P MCFARLAND
-----------------------------------------------------
Credential | CPO
-----------------------------------------------------
Telephone | 714-738-4769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------