MEDICARE: DESERT PROSTHETICS & ORTHOTICS

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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588746887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT PROSTHETICS & ORTHOTICS

Provider Business Mailing Address
First Line	:	68860 PEREZ RD STE G
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-7248
Country	:	US
Telephone Number	:	760-770-4620
Fax Number	:	760-770-4622

Provider Business Practice Location Address
First Line	:	68860 PEREZ RD STE G
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-7248
Country	:	US
Telephone Number	:	760-770-4620
Fax Number	:	760-770-4622

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NEAL COLLINS
Credential	:	CPO
Telephone Number	:	760-770-4620

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	12/03/2010

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