PROSTHETIC & ORTHOTIC GROUP SAN GABRIEL VALLEY, INC (NPI# 1548718612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548718612 |
| Entity Type | Organization |
| Organization Name | PROSTHETIC & ORTHOTIC GROUP SAN GABRIEL VALLEY, INC |
| Practice Address |
931 Buena Vista St Ste 105 Duarte CA 91010 |
| Mailing Address |
931 Buena Vista St Ste 105 Duarte CA 91010-1780 |
| Practice Telephone | 6262561415 |
| Practice Fax Number | 6262561405 |
| Mailing Telephone | 6262561415 |
| Mailing Fax Number | 6262561405 |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2018-06-06 |
| Authorized Official Name | MARK A RODRIGUEZ (VP) |
| Authorized Official Telephone | 6262561415 |
| Authorized Official Credential | CPO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831713189 | Prosthetic & Orthotic Group San Gabriel Valley, Inc | Prosthetic/Orthotic Supplier | 5658 Sepulveda Blvd Ste 206, Van Nuys, CA 91411-2951 | 2020-06-02 |
| Street Address |
931 BUENA VISTA ST STE 105 |
| City | DUARTE |
| State | CA |
| Zip Code | 91010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407223365 | Mark A. Rodriguez | Orthotist | 931 Buena Vista St Ste 105, Duarte, CA 91010-1780 | 2015-08-26 |
| 1174025068 | Jack E. Soulis | Orthotist | 931 Buena Vista St Ste 105, Duarte, CA 91010-1780 | 2018-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386266849 | Cheyenne King | Student in an Organized Health Care Education/Training Program | 1801 Huntington Drive, Duarte, Ca 91010, Duarte, CA 91010 | 2020-05-07 |
| 1114578028 | Cristian Gonzalez | Case Manager/Care Coordinator | 2250 E Foothill Ave, Pasadena, CA 91010 | 2019-09-23 |
| 1366932378 | Maisie Madrid | Marriage & Family Therapist | 1801 Huntington Drive, Duarte, CA 91010 | 2018-05-15 |
| 1598289571 | Bertha Maria Torres | Social Worker | 938 E. Huntington Drive, Unit A, Duarte, CA 91010 | 2017-08-01 |
| 1598292286 | Sheila Ramirez | Occupational Therapy Assistant | 2302 Citrus View Ave, Duarte, CA 91010 | 2017-05-12 |
| 1982059556 | Patricia Mendoza | Case Manager/Care Coordinator | 2502 E.huntington Dr., Duarte, CA 91010 | 2016-05-02 |
| 1770966178 | Sinziana Dumitra | Surgery | 1500 Durate Road California, Mob L001, Duarte, CA 91010 | 2015-07-02 |
| 1477940161 | Jin Sun L Bitar | Internal Medicine | 1500 Duarte Rd # Wing4, Duarte, CA 91010 | 2015-04-20 |
| 1659625622 | Jeanette Marie Petermann | Nurse Practitioner | 1036 East Huntington Drive, Duarte, CA 91010 | 2012-10-30 |
| 1649534397 | Nathaniel J Khoe Dds. Inc | Dentist | 1016 Huntington Drive, Duarte, CA 91010 | 2012-06-27 |
| Find all providers in zip 91010 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700026564 | Stellar Prosthetics and Orthotics | Prosthetic/Orthotic Supplier | 931 Buena Vista St Ste 304, Duarte, CA 91010-1714 | 2009-03-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821696592 | Cranial Technologies, Inc. | Prosthetic/Orthotic Supplier | 3031 W March Ln Ste 216w, Stockton, CA 95219-6500 | 2020-10-14 |
| 1871191742 | Alcam Medical Inc. | Prosthetic/Orthotic Supplier | 1244 N Mariposa St Ste 10, Fresno, CA 93703-3929 | 2020-10-13 |
| 1740887462 | A-z Consulting O & P Services | Prosthetic/Orthotic Supplier | 1133 Smith Ln Ste 5, Roseville, CA 95661-4131 | 2020-10-06 |
| 1255938452 | Sheek Hair Boutique | Prosthetic/Orthotic Supplier | 1432 N Cedar Ave Apt 107, Fresno, CA 93703-5303 | 2020-10-01 |
| 1922615368 | Inland Artificial Limb & Brace | Prosthetic/Orthotic Supplier | 1101 Bryan Ave Ste C, Tustin, CA 92780-4401 | 2020-09-29 |
| 1043823461 | Crystal Johnson | Prosthetic/Orthotic Supplier | 812 S Flower St Apt 4, Inglewood, CA 90301-7913 | 2020-08-25 |
| 1225640220 | Christopher Holloway | Prosthetic/Orthotic Supplier | 4517 Market St Ste 4, Ventura, CA 93003-7841 | 2020-08-20 |
| 1407468416 | Cranial Technologies, Inc. | Prosthetic/Orthotic Supplier | 488 E Valley Pkwy Ste 207, Escondido, CA 92025-3368 | 2020-08-20 |
| 1801406269 | Restore Medical Inc | Prosthetic/Orthotic Supplier | 1505 Soquel Dr Ste 4, Santa Cruz, CA 95065-1716 | 2020-07-31 |
| 1801404199 | Covering With Care | Prosthetic/Orthotic Supplier | 21350 Avalon Blvd Unit 5039, Carson, CA 90749-7032 | 2020-07-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.