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General NPI Number Information
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NPI Number | 1619243763
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Entity Type | Organization
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Legal Business Name | PREFERRED PROSTHETICS INC
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 1300 W LODI AVE SUITE H
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City | LODI
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State | CA
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Zip | 95242-3000
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Country | US
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Telephone | 209-625-8450
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Fax | 209-224-8416
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Provider Business Mailing Address
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Address Line | 1300 W LODI AVE SUITE H
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City | LODI
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State | CA
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Zip | 95242-3000
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Country | US
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Telephone | 209-625-8450
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Fax | 209-224-8416
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN CHARLES VERA
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Credential |
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Telephone | 209-625-8450
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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 |
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License Number State |
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