Provider Demographics
NPI:1326206392
Name:SARDO, KEITH RYAN (CPO)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:RYAN
Last Name:SARDO
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E ROMIE LN
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4026
Mailing Address - Country:US
Mailing Address - Phone:831-422-9646
Mailing Address - Fax:831-422-3527
Practice Address - Street 1:535 E ROMIE LN
Practice Address - Street 2:SUITE 3
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4026
Practice Address - Country:US
Practice Address - Phone:831-422-9646
Practice Address - Fax:831-422-3527
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO02701222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist