Provider Demographics
NPI:1366855124
Name:PROSTHETIC & ORTHOTIC MANAGEMENT INC
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC MANAGEMENT INC
Other - Org Name:COACHELLA VALLEY ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:760-964-3030
Mailing Address - Street 1:75150 SHERYL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5118
Mailing Address - Country:US
Mailing Address - Phone:760-345-4779
Mailing Address - Fax:760-772-3904
Practice Address - Street 1:75150 SHERYL AVE STE A
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5118
Practice Address - Country:US
Practice Address - Phone:760-345-4779
Practice Address - Fax:760-772-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies