Provider Demographics
NPI:1306861232
Name:KOLMAN PROSTHETICS ORTHOTICS,INC.
Entity Type:Organization
Organization Name:KOLMAN PROSTHETICS ORTHOTICS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSHTETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FREIRE
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:562-698-0988
Mailing Address - Street 1:7633 GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1626
Mailing Address - Country:US
Mailing Address - Phone:562-698-0988
Mailing Address - Fax:562-696-8791
Practice Address - Street 1:7633 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1626
Practice Address - Country:US
Practice Address - Phone:562-698-0988
Practice Address - Fax:562-696-8791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGFC000150Medicaid
CA0164940001Medicare PIN