Provider Demographics
NPI:1538163878
Name:ORTHOPROS INC
Entity type:Organization
Organization Name:ORTHOPROS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERNKNOPF
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:310-828-7485
Mailing Address - Street 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:STE 104E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2208
Mailing Address - Country:US
Mailing Address - Phone:310-828-7485
Mailing Address - Fax:310-828-7067
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:STE 104E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2208
Practice Address - Country:US
Practice Address - Phone:310-828-7485
Practice Address - Fax:310-828-7067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000350Medicaid
0200100001Medicare ID - Type Unspecified