Provider Demographics
NPI:1346343365
Name:SANDRA L VITALE
Entity Type:Organization
Organization Name:SANDRA L VITALE
Other - Org Name:TURLOCK ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-634-9021
Mailing Address - Street 1:130 REGIS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1129
Mailing Address - Country:US
Mailing Address - Phone:209-634-9021
Mailing Address - Fax:209-634-9023
Practice Address - Street 1:130 REGIS ST
Practice Address - Street 2:SUITE A
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1129
Practice Address - Country:US
Practice Address - Phone:209-634-9021
Practice Address - Fax:209-634-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0006060Medicaid
CA0749610001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.