Provider Demographics
NPI:1720396690
Name:PROSTHETIC & ORTHOTIC GROUP LOS ANGELES, INC
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC GROUP LOS ANGELES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-348-9090
Mailing Address - Street 1:5837A UPLANDER WAY
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6607
Mailing Address - Country:US
Mailing Address - Phone:310-348-9090
Mailing Address - Fax:310-348-9099
Practice Address - Street 1:5837A UPLANDER WAY
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6607
Practice Address - Country:US
Practice Address - Phone:310-348-9090
Practice Address - Fax:310-348-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier