Provider Demographics
NPI:1508397514
Name:VITO'S PEDORTHIC CENTER
Entity Type:Organization
Organization Name:VITO'S PEDORTHIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDORTHIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DJABOURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:626-858-9460
Mailing Address - Street 1:143 E ROWLAND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3065
Mailing Address - Country:US
Mailing Address - Phone:626-858-9460
Mailing Address - Fax:626-858-9767
Practice Address - Street 1:143 E ROWLAND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3065
Practice Address - Country:US
Practice Address - Phone:626-858-9460
Practice Address - Fax:626-858-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty