Provider Demographics
NPI:1508911173
Name:J & J ARTIFICIAL LIMB & BRACE LLC
Entity Type:Organization
Organization Name:J & J ARTIFICIAL LIMB & BRACE LLC
Other - Org Name:J & J
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEJANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-613-0958
Mailing Address - Street 1:11411 W BERNARDO CT.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127
Mailing Address - Country:US
Mailing Address - Phone:858-613-0958
Mailing Address - Fax:858-613-0959
Practice Address - Street 1:11411 W BERNARDO CT.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127
Practice Address - Country:US
Practice Address - Phone:858-613-0958
Practice Address - Fax:858-613-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO1661335E00000X
CACO004434335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000850Medicaid
CAGXC000850Medicaid