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General NPI Number Information
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NPI Number | 1700026564
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Entity Type | Organization
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Legal Business Name | STELLAR PROSTHETICS AND ORTHOTICS
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 2930 INLAND EMPIRE BLVD STE 118
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City | ONTARIO
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State | CA
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Zip | 91764-7415
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Country | US
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Telephone | 909-906-6624
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Fax | 909-930-1299
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Provider Business Mailing Address
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Address Line | 753 S ARROYO PKWY SUITE 2
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City | PASADENA
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State | CA
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Zip | 91105-3902
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Country | US
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Telephone | 626-584-0805
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Fax | 626-584-0806
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Authorized Official
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Title or Position | CEO
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Name | MR. SEAN L STELLAR
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Credential | CPO
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Telephone | 626-584-0805
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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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