Provider Demographics
NPI:1598879629
Name:GIVENS, LOUIS (ORTHOTIST PROSTHETIS)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:GIVENS
Suffix:
Gender:M
Credentials:ORTHOTIST PROSTHETIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 W JULIAN ST UNIT 427
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2488
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-852-3267
Practice Address - Street 1:3801 MIRANDA AVE # 121
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-852-3267
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO18601744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1860OtherORTHOTIST/PROSTHETIST