=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720518798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROSTHETIC & ORTHOTIC GROUP ORANGE COUNTY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2017
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26300 LA ALAMEDA STE 120
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-242-2237
-----------------------------------------------------
Fax | 949-367-0277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26300 LA ALAMEDA STE 120
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-272-2237
-----------------------------------------------------
Fax | 949-367-0277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | GLENN MATSUSHIMA
-----------------------------------------------------
Credential | CPO
-----------------------------------------------------
Telephone | 949-272-2237
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------