Provider Demographics
NPI:1467539106
Name:HEALY, MARY (CPO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HEALY
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19749 SCARLET MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1304
Mailing Address - Country:US
Mailing Address - Phone:661-309-1264
Mailing Address - Fax:
Practice Address - Street 1:11301 WILSHIRE BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4763
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO7371744P3200X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA222Z00000XOtherORTHOTIST
CA224P00000XOtherPROSTHETIST