Provider Demographics
NPI:1538338033
Name:ALL CITIES ORTHOPEDICS, INC
Entity type:Organization
Organization Name:ALL CITIES ORTHOPEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUEVANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:ORTHOTIST/PROSTHETIS
Authorized Official - Phone:310-638-9806
Mailing Address - Street 1:11101 ATLANTIC AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3003
Mailing Address - Country:US
Mailing Address - Phone:310-638-9806
Mailing Address - Fax:310-638-9846
Practice Address - Street 1:11101 ATLANTIC AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3003
Practice Address - Country:US
Practice Address - Phone:310-638-9806
Practice Address - Fax:310-638-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103642335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXA0129950Medicaid
CAXA0129950Medicaid