Provider Demographics
NPI:1255542668
Name:FURUSHIRO, RANDY FURUSHIRO (CPO)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:FURUSHIRO
Last Name:FURUSHIRO
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7531 WATERVILLE PL
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3088
Mailing Address - Country:US
Mailing Address - Phone:408-848-4446
Mailing Address - Fax:408-848-4446
Practice Address - Street 1:535 E ROMIE LN STE 3
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4026
Practice Address - Country:US
Practice Address - Phone:408-848-4446
Practice Address - Fax:408-848-4446
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO851222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXC0008510Medicaid