Provider Demographics
NPI:1245534510
Name:AESTHETIC PROSTHETICS, INC.
Entity type:Organization
Organization Name:AESTHETIC PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:JOHANNES
Authorized Official - Last Name:KNAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MAMS, CPO
Authorized Official - Phone:626-345-0050
Mailing Address - Street 1:1095 N ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3204
Mailing Address - Country:US
Mailing Address - Phone:626-345-0050
Mailing Address - Fax:626-345-0052
Practice Address - Street 1:1095 N ALLEN AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-3204
Practice Address - Country:US
Practice Address - Phone:626-345-0050
Practice Address - Fax:626-345-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACPO01364335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier