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General NPI Number Information
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NPI Number | 1700828944
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Entity Type | Organization
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Legal Business Name | BLUEBIRD ORTHOTICS AND PROSTHETICS, INC.
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 4373 VIEWRIDGE AVE STE A
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City | SAN DIEGO
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State | CA
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Zip | 92123-1619
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Country | US
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Telephone | 858-874-6750
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Fax | 858-874-6736
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Provider Business Mailing Address
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Address Line | 4373 VIEWRIDGE AVE STE A
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 858-874-6750
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Fax | 858-874-6736
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KAREN MAYA
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Credential |
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Telephone | 858-874-6750
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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 | 97948241
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License Number State | CA
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