Provider Demographics
NPI:1669759486
Name:CRANIAL TECHNOLOGIES INC
Entity type:Organization
Organization Name:CRANIAL TECHNOLOGIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE & MEDICAID SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:OUMOU
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-393-8188
Mailing Address - Street 1:1405 W AUTO DR FL 2
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1016
Mailing Address - Country:US
Mailing Address - Phone:480-403-6300
Mailing Address - Fax:480-505-1842
Practice Address - Street 1:12301 WILSHIRE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1007
Practice Address - Country:US
Practice Address - Phone:310-231-3406
Practice Address - Fax:310-231-3529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRANIAL TECHNOLOGIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-08
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier