Provider Demographics
NPI:1437593514
Name:ALEX'S COMFORT SHOES
Entity Type:Organization
Organization Name:ALEX'S COMFORT SHOES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:DURANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-642-3015
Mailing Address - Street 1:5333 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3539
Mailing Address - Country:US
Mailing Address - Phone:916-642-3015
Mailing Address - Fax:
Practice Address - Street 1:5333 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3539
Practice Address - Country:US
Practice Address - Phone:916-642-3015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier