Provider Demographics
NPI:1669547733
Name:INLAND ARTIFICIAL LIMB & BRACE
Entity type:Organization
Organization Name:INLAND ARTIFICIAL LIMB & BRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:951-734-1835
Mailing Address - Street 1:680 PARKRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3124
Mailing Address - Country:US
Mailing Address - Phone:951-734-1835
Mailing Address - Fax:951-734-1538
Practice Address - Street 1:1700 E LINCOLN AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4346
Practice Address - Country:US
Practice Address - Phone:714-502-9354
Practice Address - Fax:714-502-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABUS200505279335E00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000871Medicaid
CA5554470003Medicare NSC