MEDICARE: WEST COAST 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	:	1942354584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COAST PROSTHETICS

Provider Business Mailing Address
First Line	:	707 CANYON CREEK WAY
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-3028
Country	:	US
Telephone Number	:	916-689-7528
Fax Number	:	916-689-4428

Provider Business Practice Location Address
First Line	:	65 QUINTA CT STE I
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4310
Country	:	US
Telephone Number	:	916-689-7528
Fax Number	:	916-689-4428

Authorized Official
Title or Position	:	CERTIFIED PROSTHETIST, OWNER
Name	:	MR. STEVE VERA
Credential	:	CP
Telephone Number	:	916-689-7528

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	06/27/2008

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Directions to “WEST COAST PROSTHETICS ” Practice Location

Language	Start Address	Practice Location

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