Provider Demographics
NPI:1508845702
Name:REDLANDS PROSTHETIC & ORTHOTIC GROUP INC
Entity Type:Organization
Organization Name:REDLANDS PROSTHETIC & ORTHOTIC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RASHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-798-5853
Mailing Address - Street 1:1849 W REDLANDS BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-3127
Mailing Address - Country:US
Mailing Address - Phone:909-798-5853
Mailing Address - Fax:909-798-0602
Practice Address - Street 1:1849 W REDLANDS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3127
Practice Address - Country:US
Practice Address - Phone:909-798-5853
Practice Address - Fax:909-798-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXC0013090Medicaid
CAZZZ25483ZOtherBLUE SHIELD OF CA
CAXC0013090Medicaid