Provider Demographics
NPI:1639441009
Name:DYNAMIC ORTHO
Entity Type:Organization
Organization Name:DYNAMIC ORTHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:AVAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-819-2773
Mailing Address - Street 1:943 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-1916
Mailing Address - Country:US
Mailing Address - Phone:323-819-2773
Mailing Address - Fax:818-845-5925
Practice Address - Street 1:943 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-1916
Practice Address - Country:US
Practice Address - Phone:323-819-2773
Practice Address - Fax:818-845-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies