Provider Demographics
NPI:1124738257
Name:ABLE ORTHO CLINIC INC
Entity type:Organization
Organization Name:ABLE ORTHO CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-561-2087
Mailing Address - Street 1:2982 MCDONALD LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8212
Mailing Address - Country:US
Mailing Address - Phone:310-561-2087
Mailing Address - Fax:
Practice Address - Street 1:1411 RIMPAU AVE STE 110
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-2681
Practice Address - Country:US
Practice Address - Phone:951-531-8035
Practice Address - Fax:951-929-5033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABLE ORTHO CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier