Provider Demographics
NPI:1598799090
Name:ACTION ORTHOPEDIC COMPANY, LLC
Entity Type:Organization
Organization Name:ACTION ORTHOPEDIC COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAROLA
Authorized Official - Middle Name:LUCY
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-482-5226
Mailing Address - Street 1:265 S WESTERN AVE UNIT 74368
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4172
Mailing Address - Country:US
Mailing Address - Phone:213-482-5226
Mailing Address - Fax:213-482-5040
Practice Address - Street 1:1515 WILSHIRE BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2216
Practice Address - Country:US
Practice Address - Phone:213-482-5226
Practice Address - Fax:213-482-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0012281Medicaid
CA0257870001Medicare NSC
CA6119260001Medicare NSC