Provider Demographics
NPI:1013440932
Name:ESSENTIAL ORTHOTICS AND PROSTHETICS INC
Entity Type:Organization
Organization Name:ESSENTIAL ORTHOTICS AND PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:METICHECCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:661-886-5828
Mailing Address - Street 1:360 GRAND CYPRESS AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1416
Mailing Address - Country:US
Mailing Address - Phone:661-723-3700
Mailing Address - Fax:661-723-3799
Practice Address - Street 1:360 GRAND CYPRESS AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3646
Practice Address - Country:US
Practice Address - Phone:661-723-3700
Practice Address - Fax:661-723-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32836335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier