MEDICARE: RABBIT'S FOOT ORTHOTICS AND PROSTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1306270798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RABBIT'S FOOT ORTHOTICS AND PROSTHETICS

Provider Business Mailing Address
First Line	:	12540 OAKS NORTH DR
Second Line	:	SUITE B3
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-1608
Country	:	US
Telephone Number	:	858-943-1691
Fax Number	:	858-451-3097

Provider Business Practice Location Address
First Line	:	12540 OAKS NORTH DR
Second Line	:	SUITE B3
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-1608
Country	:	US
Telephone Number	:	858-943-1691
Fax Number	:	858-451-3097

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ADRIAN RAVITZ
Credential	:	CO
Telephone Number	:	858-943-1691

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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