Provider Demographics
NPI:1639404015
Name:SOUTHERN CALIFORNIA PROSTHETICS, INC.
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-533-8349
Mailing Address - Street 1:1801 PARKCOURT PL
Mailing Address - Street 2:BLDG B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5002
Mailing Address - Country:US
Mailing Address - Phone:949-892-5338
Mailing Address - Fax:949-419-6478
Practice Address - Street 1:1801 PARKCOURT PL
Practice Address - Street 2:BLDG B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5002
Practice Address - Country:US
Practice Address - Phone:949-892-5338
Practice Address - Fax:949-419-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6380180001Medicare NSC