Provider Demographics
NPI:1336456193
Name:QUALITY CARE PROSTHETICS & ORTHOTICS, INC.
Entity Type:Organization
Organization Name:QUALITY CARE PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:QUALITY CARE PROSTHETICS & ORTHOTICS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:I
Authorized Official - Credentials:CPO
Authorized Official - Phone:714-342-0833
Mailing Address - Street 1:1665 W KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-3021
Mailing Address - Country:US
Mailing Address - Phone:714-643-9206
Mailing Address - Fax:714-643-9467
Practice Address - Street 1:1665 W KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-3021
Practice Address - Country:US
Practice Address - Phone:714-643-9206
Practice Address - Fax:714-643-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABUS2010-02405335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134349806OtherNPI
CA1134349806OtherNPI