Provider Demographics
NPI:1891083473
Name:DIABLO PROSTHETICS AND ORTHOTICS, INC
Entity Type:Organization
Organization Name:DIABLO PROSTHETICS AND ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PELZ
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:925-552-5100
Mailing Address - Street 1:PO BOX 5268
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-0468
Mailing Address - Country:US
Mailing Address - Phone:925-484-6400
Mailing Address - Fax:925-484-6497
Practice Address - Street 1:5601 NORRIS CANYON RD
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5407
Practice Address - Country:US
Practice Address - Phone:925-552-5100
Practice Address - Fax:925-552-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891083473Medicaid
CA1891083473Medicaid