Provider Demographics
NPI:1902087802
Name:ANAHEIM ORTHOTICS AND ORTHOPEDIC APPLIANCES
Entity Type:Organization
Organization Name:ANAHEIM ORTHOTICS AND ORTHOPEDIC APPLIANCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CERTIFIED PEDORTHIST
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARTCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:714-632-3263
Mailing Address - Street 1:1177 N KRAEMER BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-1917
Mailing Address - Country:US
Mailing Address - Phone:714-632-3263
Mailing Address - Fax:714-632-3318
Practice Address - Street 1:1177 N KRAEMER BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-1917
Practice Address - Country:US
Practice Address - Phone:714-632-3263
Practice Address - Fax:714-632-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier