Provider Demographics
NPI:1659553907
Name:PVO HELTHCARE INC
Entity Type:Organization
Organization Name:PVO HELTHCARE INC
Other - Org Name:POMONA VALLEY ORTHOPEDIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:BUSUTTIL
Authorized Official - Suffix:
Authorized Official - Credentials:BOPCO/CO
Authorized Official - Phone:909-629-7615
Mailing Address - Street 1:367 ERVILLA ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3022
Mailing Address - Country:US
Mailing Address - Phone:909-629-7615
Mailing Address - Fax:909-623-7651
Practice Address - Street 1:367 ERVILLA ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3022
Practice Address - Country:US
Practice Address - Phone:909-629-7615
Practice Address - Fax:909-623-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4852600001Medicare NSC