Provider Demographics
NPI:1578589735
Name:LIFE-LIKE PROSTHETICS, LLC
Entity Type:Organization
Organization Name:LIFE-LIKE PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROSTHETIC PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:DURAN
Authorized Official - Last Name:SAMBRANO
Authorized Official - Suffix:
Authorized Official - Credentials:CP, BOCP, RPT
Authorized Official - Phone:310-320-5777
Mailing Address - Street 1:1319 W CARSON ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3909
Mailing Address - Country:US
Mailing Address - Phone:310-320-5777
Mailing Address - Fax:310-320-6341
Practice Address - Street 1:1319 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3909
Practice Address - Country:US
Practice Address - Phone:310-320-5777
Practice Address - Fax:310-320-6341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0015301Medicaid
CA0643420001Medicare ID - Type Unspecified
CAXB0015301Medicaid