Provider Demographics
NPI:1942732730
Name:ACTION ORTHOPEDIC COMPANY, LLC
Entity Type:Organization
Organization Name:ACTION ORTHOPEDIC COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILVER
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPO,CP
Authorized Official - Phone:213-482-5226
Mailing Address - Street 1:637 LUCAS AVE
Mailing Address - Street 2:SUITE # 609 L
Mailing Address - City:OS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1997
Mailing Address - Country:US
Mailing Address - Phone:213-482-5226
Mailing Address - Fax:213-482-5040
Practice Address - Street 1:23332 HAWTHORNE BVLD
Practice Address - Street 2:SUITE # 304
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3749
Practice Address - Country:US
Practice Address - Phone:213-215-8553
Practice Address - Fax:213-482-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598799090Medicaid