Organization
SANDRA L VITALE
Active
Other names
PACIFIC ORTHOTICS & PROSTHETICS
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDY L VITALE (OWNER)
(209) 575-1063
Entity
Organization
Contact information
Practice address
1005 W ORANGEBURG AVE, SUITE A, MODESTO, CA 95350-4163
(209) 575-1063
(209) 575-1065
Mailing address
1005 W ORANGEBURG AVE, SUITE A, MODESTO, CA 95350-4163
(209) 575-1063
(209) 575-1065
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GXC000360
—
CA
Enumeration date
09/06/2006
Last updated
06/17/2008
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