Provider Demographics
NPI:1598290793
Name:ABLE ORTHO CLINIC INC
Entity Type:Organization
Organization Name:ABLE ORTHO CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMPA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-480-8760
Mailing Address - Street 1:2982 MCDONALD LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8212
Mailing Address - Country:US
Mailing Address - Phone:310-480-8760
Mailing Address - Fax:951-929-5033
Practice Address - Street 1:475 W STETSON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7070
Practice Address - Country:US
Practice Address - Phone:951-929-5000
Practice Address - Fax:951-929-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier