Provider Demographics
NPI:1710390083
Name:QUALITY ORTHOTICS PROSTHETICS INC
Entity Type:Organization
Organization Name:QUALITY ORTHOTICS PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/PROSTHETIST
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:BOCPO/CO
Authorized Official - Phone:909-629-7615
Mailing Address - Street 1:319 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1405
Mailing Address - Country:US
Mailing Address - Phone:909-629-7615
Mailing Address - Fax:909-623-7651
Practice Address - Street 1:319 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1405
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:2014-06-04
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier