Organization
SAINT CRISPIN'S ORTHOPEDIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL C PAVELSKI CPO (PRESIDENT)
(562) 802-2477
Entity
Organization
Contact information
Practice address
12830 ROSECRANS AVE, NORWALK, CA 90650-4416
(562) 802-2477
(562) 404-1678
Mailing address
12830 ROSECRANS AVE, NORWALK, CA 90650-4416
(562) 802-2477
(562) 404-1678
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMS200045
CCS IDENTIFICATION NUMBER
CA
05
—
XC0019900
—
CA
01
—
ZZZ85855Z
BLUE SHIELD IDENT. NO.
CA
Enumeration date
05/20/2006
Last updated
08/22/2020
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