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General NPI Number Information
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NPI Number | 1790580363
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Entity Type | Organization
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Legal Business Name | AMIGOS ORTHOTICS & PROSTHETICS
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 5287 HWY 95 STE I
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-9220
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Country | US
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Telephone | 626-622-3359
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Fax |
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Provider Business Mailing Address
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Address Line | 5287 S HIGHWAY 95 STE I
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-9220
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Country | US
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Telephone | 928-863-2298
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALPHA SANUSI
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Credential |
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Telephone | 626-622-3359
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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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