# DIAMOND ORTHOTIC LABORATORY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407543176
- **Authorized official:** MATT RAGO (COO)
- **Authorized official phone:** (619) 724-6400

## Contact information

- **Practice address:** 7859 EL CAJON BLVD, LA MESA, CA 91942-0602
- **Practice address phone:** (619) 724-6400
- **Practice address fax:** (619) 724-6401
- **Mailing address:** 7859 EL CAJON BLVD, LA MESA, CA 91942-0602
- **Mailing address phone:** (619) 724-6400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | — | NULL | Yes |

## Other

- **Enumeration date:** 04/21/2023
- **Last updated:** 04/21/2023