Organization
ANACAPA PROSTHETIC AND ORTHOTIC LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT CHACON (PRESIDENT)
(805) 216-2635
Entity
Organization
Contact information
Practice address
2300 KNOLL DR, UNIT D, VENTURA, CA 93003-8057
(805) 658-1388
(805) 658-2636
Mailing address
7425 PIERCE ST, VENTURA, CA 93003-2586
(805) 216-2635
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255329736
—
CA
05
—
CMS160156
—
CA
05
—
GFA000040
—
CA
Enumeration date
10/10/2005
Last updated
05/06/2024
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