Provider Demographics
NPI:1720518798
Name:PROSTHETIC & ORTHOTIC GROUP ORANGE COUNTY, LLC
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC GROUP ORANGE COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARQUIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:949-272-2237
Mailing Address - Street 1:26300 LA ALAMEDA STE 120
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6380
Mailing Address - Country:US
Mailing Address - Phone:949-272-2237
Mailing Address - Fax:949-367-0277
Practice Address - Street 1:26300 LA ALAMEDA STE 120
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6380
Practice Address - Country:US
Practice Address - Phone:949-242-2237
Practice Address - Fax:949-367-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720518798Medicaid