Provider Demographics
NPI:1033413075
Name:PREFERRED PROSTHETICS INC
Entity Type:Organization
Organization Name:PREFERRED PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:C
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:ABC-CP, BOC-O
Authorized Official - Phone:916-896-5702
Mailing Address - Street 1:3215 N CALIFORNIA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3433
Mailing Address - Country:US
Mailing Address - Phone:209-932-9746
Mailing Address - Fax:209-932-9765
Practice Address - Street 1:3215 N CALIFORNIA ST STE 2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3433
Practice Address - Country:US
Practice Address - Phone:209-932-9746
Practice Address - Fax:209-932-9765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6479600001Medicare NSC