Provider Demographics
NPI:1386636322
Name:ALEXANDER ORTHOPEDIC LAB
Entity Type:Organization
Organization Name:ALEXANDER ORTHOPEDIC LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO FAAOP
Authorized Official - Phone:310-674-9179
Mailing Address - Street 1:660 E REGENT ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1415
Mailing Address - Country:US
Mailing Address - Phone:310-674-9179
Mailing Address - Fax:310-674-0120
Practice Address - Street 1:660 E REGENT ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1415
Practice Address - Country:US
Practice Address - Phone:310-674-9179
Practice Address - Fax:310-674-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO-02424OtherABC
C13843OtherBOC
CAXC0011380Medicaid
CA0266510001Medicare ID - Type Unspecified