# WEST COAST DME & SUPPLIES LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WEST COAST DME & SUPPLIES LLC
- **Other names:** OrthoKinetix
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1255998290
- **Legal business name:** WEST COAST DME & SUPPLIES LLC
- **Authorized official:** MR. MICHAEL GREGORY WELLS C.PED (PRESIDENT)
- **Authorized official phone:** (909) 908-3920

## Contact information

- **Practice address:** 8322 CLAIREMONT MESA BLVD STE 105, SAN DIEGO, CA 92111-1317
- **Practice address phone:** (909) 477-3117
- **Practice address fax:** (909) 303-9244
- **Mailing address:** 1835 CHICAGO AVE STE A, RIVERSIDE, CA 92507-2309
- **Mailing address phone:** (909) 477-3117

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 222Z00000X | Orthotist | — | NULL | — |
| 222Z00000X | Orthotist | — | — | — |
| 224L00000X | Pedorthist | — | NULL | — |
| 224L00000X | Pedorthist | — | — | — |
| 224P00000X | Prosthetist | — | NULL | — |
| 224P00000X | Prosthetist | — | — | — |
| 225000000X | Orthotic Fitter | — | NULL | — |
| 225000000X | Orthotic Fitter | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 05/24/2019
- **Last updated:** 05/24/2019