Provider Demographics
NPI:1659398204
Name:ALPHA ORTHOPEDIC APPLIANCE CO A CORP
Entity Type:Organization
Organization Name:ALPHA ORTHOPEDIC APPLIANCE CO A CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CERTIFIED PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:YAMAKA
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:323-721-6706
Mailing Address - Street 1:5940 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2413
Mailing Address - Country:US
Mailing Address - Phone:323-721-6706
Mailing Address - Fax:323-721-6746
Practice Address - Street 1:5940 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2413
Practice Address - Country:US
Practice Address - Phone:323-721-6706
Practice Address - Fax:323-721-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGFB000030Medicaid
CA0765400001Medicare NSC