=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730362427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTION ONE PATIENT CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2007
-----------------------------------------------------
Last Update Date | 12/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1207 VALLEY VIEW RD UNIT D
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91202-1745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-531-2731
-----------------------------------------------------
Fax | 818-241-0596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1207 VALLEY VIEW RD UNIT D
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91202-1745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-531-2731
-----------------------------------------------------
Fax | 818-241-0596
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JESUS MARTINEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-531-2731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------