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General NPI Number Information
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NPI Number | 1932187218
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Entity Type | Organization
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Legal Business Name | TUCSON ORTHOPEDIC LAB LLC
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 3818 E 5TH ST
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City | TUCSON
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State | AZ
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Zip | 85716-5145
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Country | US
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Telephone | 520-319-0339
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Fax | 520-319-7825
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Provider Business Mailing Address
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Address Line | PO BOX 43863
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City | TUCSON
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State | AZ
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Zip | 85733-3863
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Country | US
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Telephone | 520-319-0339
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Fax | 520-319-7825
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANNY CHAN
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Credential | C.O.
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Telephone | 520-319-0339
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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 | AZ
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