Provider Demographics
NPI:1932890837
Name:PROSTHETIC & ORTHOTIC MANAGEMENT INC
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:760-345-4779
Mailing Address - Street 1:1080 N INDIAN CANYON DR STE 203
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4871
Mailing Address - Country:US
Mailing Address - Phone:760-345-4779
Mailing Address - Fax:760-772-3904
Practice Address - Street 1:1080 N INDIAN CANYON DR STE 203
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4871
Practice Address - Country:US
Practice Address - Phone:760-345-4779
Practice Address - Fax:760-772-3904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COACHELLA VALLEY ORTHOTICS & PROSTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies