Provider Demographics
NPI:1255863726
Name:VALLEY ORTHOPEDIC TECHNOLOGY, INC
Entity Type:Organization
Organization Name:VALLEY ORTHOPEDIC TECHNOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCPO
Authorized Official - Phone:818-600-2560
Mailing Address - Street 1:15243 VANOWEN STREET #208
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-600-2560
Mailing Address - Fax:818-600-2561
Practice Address - Street 1:15243 VANOWEN STREET #208
Practice Address - Street 2:SUITE 208
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-600-2560
Practice Address - Fax:818-600-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255863726Medicaid