Basic Information
| Provider Information | |||||||||
| NPI: | 1326398751 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DESERT PROSTHETICS & ORTHOTICS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81709 DR. CARREON BLVD. | ||||||||
| Address2: | SUITE D2 | ||||||||
| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922015509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603428200 | ||||||||
| FaxNumber: | 7603428266 | ||||||||
| Practice Location | |||||||||
| Address1: | 81709 DR. CARREON BLVD. | ||||||||
| Address2: | SUITE D2 | ||||||||
| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922015509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603428200 | ||||||||
| FaxNumber: | 7603428266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2012 | ||||||||
| LastUpdateDate: | 09/13/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COLLINS | ||||||||
| AuthorizedOfficialFirstName: | NEAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7603428200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CERTIFIED PROTHETIS/ | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X | 13-00011234 | CA | Y | Suppliers | Prosthetic/Orthotic Supplier |
No ID Information.