Provider Demographics
NPI:1285965392
Name:AMERICAN ORTHOTICS & PROSTHETICS
Entity type:Organization
Organization Name:AMERICAN ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SULIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:951-367-6702
Mailing Address - Street 1:PO BOX 2786
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92516-2786
Mailing Address - Country:US
Mailing Address - Phone:909-473-9308
Mailing Address - Fax:951-367-6702
Practice Address - Street 1:1800 WESTERN AVE STE 205
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1356
Practice Address - Country:US
Practice Address - Phone:909-473-9308
Practice Address - Fax:951-367-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
CACPO02649335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXA0029550Medicaid
CACMS168487OtherCALIFORNIA CHILDRENS SERVICES
CACMS168487OtherCALIFORNIA CHILDRENS SERVICES