Provider Demographics
NPI:1922590074
Name:PIONEER ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:PIONEER ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRSHAHROKHI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:949-945-9606
Mailing Address - Street 1:7725 GATEWAY UNIT 4338
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-5807
Mailing Address - Country:US
Mailing Address - Phone:949-945-9606
Mailing Address - Fax:949-945-9604
Practice Address - Street 1:23672 BIRTCHER DR UNIT A
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1711
Practice Address - Country:US
Practice Address - Phone:949-945-9606
Practice Address - Fax:949-945-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier