Provider Demographics
NPI:1710314497
Name:WEST COAST PROSTHETICS INCORPORATED
Entity Type:Organization
Organization Name:WEST COAST PROSTHETICS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:MOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:626-256-6360
Mailing Address - Street 1:210 KRUSE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4831
Mailing Address - Country:US
Mailing Address - Phone:626-256-6360
Mailing Address - Fax:
Practice Address - Street 1:210 KRUSE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-4831
Practice Address - Country:US
Practice Address - Phone:626-256-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier