Provider Demographics
NPI:1992008387
Name:CAROL LEWIS STOLPE, BCO, LLC
Entity Type:Organization
Organization Name:CAROL LEWIS STOLPE, BCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLPE
Authorized Official - Suffix:
Authorized Official - Credentials:BCO,
Authorized Official - Phone:310-271-8801
Mailing Address - Street 1:435 N BEDFORD DR
Mailing Address - Street 2:SUITE 411
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4321
Mailing Address - Country:US
Mailing Address - Phone:310-271-8801
Mailing Address - Fax:310-271-6189
Practice Address - Street 1:435 N BEDFORD DR
Practice Address - Street 2:SUITE 411
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4321
Practice Address - Country:US
Practice Address - Phone:310-271-8801
Practice Address - Fax:310-271-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM0096453335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6105500001OtherPTAN