Provider Demographics
NPI:1205187218
Name:APEX PROSTHETICS INSTITUTE OF SAN DIEGO
Entity Type:Organization
Organization Name:APEX PROSTHETICS INSTITUTE OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CP, DC
Authorized Official - Phone:619-501-5383
Mailing Address - Street 1:3585 5TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5081
Mailing Address - Country:US
Mailing Address - Phone:619-501-5383
Mailing Address - Fax:619-501-5390
Practice Address - Street 1:3585 5TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5081
Practice Address - Country:US
Practice Address - Phone:619-501-5383
Practice Address - Fax:619-501-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP003901335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier