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General NPI Number Information
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NPI Number | 1902087802
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Entity Type | Organization
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Legal Business Name | ANAHEIM ORTHOTICS AND ORTHOPEDIC APPLIANCES
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 1177 N KRAEMER BLVD
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City | ANAHEIM
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State | CA
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Zip | 92806-1917
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Country | US
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Telephone | 714-632-3263
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Fax | 714-632-3318
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Provider Business Mailing Address
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Address Line | 1177 N KRAEMER BLVD
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City | ANAHEIM
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State | CA
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Zip | 92806-1917
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Country | US
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Telephone | 714-632-3263
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Fax | 714-632-3318
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Authorized Official
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Title or Position | OWNER CERTIFIED PEDORTHIST
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Name | BRAD A BARTCZAK
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Credential | CPED
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Telephone | 714-632-3263
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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 | CA
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