Provider Demographics
NPI:1790580363
Name:AMIGOS ORTHOTICS & PROSTHETICS
Entity type:Organization
Organization Name:AMIGOS ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-622-3359
Mailing Address - Street 1:1968 S COAST HWY # 419
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5287 HWY 95 STE I
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9220
Practice Address - Country:US
Practice Address - Phone:626-622-3359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier