MEDICARE: JESSE RASMUSSEN CPO

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	222Z00000X	Orthotist
2	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1366121576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE RASMUSSEN CPO

Provider Business Mailing Address
First Line	:	15602 MOSHER AVE
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-6427
Country	:	US
Telephone Number	:	949-474-2050
Fax Number	:	949-474-4460

Provider Business Practice Location Address
First Line	:	1530 S SINCLAIR ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-5933
Country	:	US
Telephone Number	:	949-474-2050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2023
Last Update Date	:	07/14/2023

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