Provider Demographics
NPI:1598038614
Name:AMERICAN ORTHOTICS & PROSTHETICS
Entity type:Organization
Organization Name:AMERICAN ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULIS
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
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:951-367-6702
Mailing Address - Fax:951-367-7789
Practice Address - Street 1:1666 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1260
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:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier