Provider Demographics
NPI:1215958368
Name:WEST COAST ORTHOTIC & PROSTHETIC SERVICES INC
Entity type:Organization
Organization Name:WEST COAST ORTHOTIC & PROSTHETIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:VERA
Authorized Official - Suffix:SR
Authorized Official - Credentials:CO
Authorized Official - Phone:209-550-0100
Mailing Address - Street 1:1705 COFFEE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-550-0100
Mailing Address - Fax:209-550-0117
Practice Address - Street 1:1705 COFFEE RD
Practice Address - Street 2:STE 3
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-550-0100
Practice Address - Fax:209-550-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000700Medicaid
CAGXC000700Medicaid