Provider Demographics
NPI:1376568162
Name:HUMAN DESIGNS PROSTHETIC AND ORTHOTIC LABORATORY INC.
Entity Type:Organization
Organization Name:HUMAN DESIGNS PROSTHETIC AND ORTHOTIC LABORATORY INC.
Other - Org Name:HUMAN DESIGNS PROSTHETICS AND ORTHOTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:626-445-7797
Mailing Address - Street 1:49 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2307
Mailing Address - Country:US
Mailing Address - Phone:626-445-7797
Mailing Address - Fax:626-445-7873
Practice Address - Street 1:49 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2307
Practice Address - Country:US
Practice Address - Phone:626-445-7797
Practice Address - Fax:626-445-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0016931Medicaid
CAXB0016931Medicaid