Provider Demographics
NPI:1285735274
Name:RESEDA PROSTHETICS, INC.
Entity type:Organization
Organization Name:RESEDA PROSTHETICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARACELI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-993-5441
Mailing Address - Street 1:18441 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3309
Mailing Address - Country:US
Mailing Address - Phone:818-993-5441
Mailing Address - Fax:818-993-4311
Practice Address - Street 1:18441 BRYANT ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3309
Practice Address - Country:US
Practice Address - Phone:818-993-5441
Practice Address - Fax:818-993-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13-760743332BC3200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000380Medicaid
CA0191250001Medicare NSC