Provider Demographics
NPI:1073738563
Name:WEST COAST ORTHOTIC AND PROSTHETIC
Entity Type:Organization
Organization Name:WEST COAST ORTHOTIC AND PROSTHETIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT CORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-845-8231
Mailing Address - Street 1:693 HI TECH PKWY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9372
Mailing Address - Country:US
Mailing Address - Phone:209-845-8231
Mailing Address - Fax:209-845-2883
Practice Address - Street 1:1745 W KETTLEMAN LN
Practice Address - Street 2:SUITE A
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9287
Practice Address - Country:US
Practice Address - Phone:209-333-1148
Practice Address - Fax:209-333-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier