Provider Demographics
NPI:1720144330
Name:ASSOCIATED PROSTHETICS AND ORTHOTICS
Entity Type:Organization
Organization Name:ASSOCIATED PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:RUBEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:562-531-2357
Mailing Address - Street 1:5241 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2121
Mailing Address - Country:US
Mailing Address - Phone:562-531-2357
Mailing Address - Fax:562-531-2359
Practice Address - Street 1:5241 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2121
Practice Address - Country:US
Practice Address - Phone:562-531-2357
Practice Address - Fax:562-531-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6112540001Medicare NSC