Provider Demographics
NPI:1346569175
Name:ESSENTIAL ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:ESSENTIAL ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:METICHECCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-886-5828
Mailing Address - Street 1:360 GRAND CYPRESS AVE
Mailing Address - Street 2:UNIT 304
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1422
Mailing Address - Country:US
Mailing Address - Phone:661-723-3700
Mailing Address - Fax:661-723-3799
Practice Address - Street 1:41758 12TH ST W STE A
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1421
Practice Address - Country:US
Practice Address - Phone:661-723-3700
Practice Address - Fax:661-723-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC46460335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier