Provider Demographics
NPI:1003804071
Name:R AND J PROSTHETIC APPLIANCE CO. INC.
Entity Type:Organization
Organization Name:R AND J PROSTHETIC APPLIANCE CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:805-643-4063
Mailing Address - Street 1:2407 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2603
Mailing Address - Country:US
Mailing Address - Phone:805-643-4063
Mailing Address - Fax:805-643-5876
Practice Address - Street 1:2407 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2603
Practice Address - Country:US
Practice Address - Phone:805-643-4063
Practice Address - Fax:805-643-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ700802OtherCALIF STATE I.D.
CAGFC000170Medicaid
CA0328700001Medicare ID - Type UnspecifiedZZZ70080Z