Provider Demographics
NPI:1750496816
Name:VENTURA PROSTHETIC & ORTHOTICS, INC.
Entity Type:Organization
Organization Name:VENTURA PROSTHETIC & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTIG
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:805-339-0670
Mailing Address - Street 1:1645 DONLON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5667
Mailing Address - Country:US
Mailing Address - Phone:805-339-0670
Mailing Address - Fax:805-339-0493
Practice Address - Street 1:1645 DONLON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5667
Practice Address - Country:US
Practice Address - Phone:805-339-0670
Practice Address - Fax:805-339-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000790Medicaid
CA4171780001Medicare NSC