Provider Demographics
NPI:1073569554
Name:PROSTHETIC & ORTHOTIC GROUP, INC
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-595-6445
Mailing Address - Street 1:2669 MYRTLE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2745
Mailing Address - Country:US
Mailing Address - Phone:562-595-6445
Mailing Address - Fax:562-424-3122
Practice Address - Street 1:2669 MYRTLE AVE
Practice Address - Street 2:STE 101
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755
Practice Address - Country:US
Practice Address - Phone:562-595-6445
Practice Address - Fax:562-424-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000190Medicaid
CA4203460001Medicare NSC