# WEST COAST ORTHOTIC LABS

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

## Provider details

- **NPI number:** 1457531824
- **Authorized official:** PARK METHA (PRESIDENT)
- **Authorized official phone:** (909) 946-5562

## Contact information

- **Practice address:** 163 ENTERPRISE WAY, UPLAND, CA 91786-1509
- **Practice address phone:** (909) 946-5562
- **Mailing address:** 163 ENTERPRISE WAY, UPLAND, CA 91786-1509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 11/13/2007
- **Last updated:** 11/13/2007