Organization
BEVERLY ORTHOPEDIC LABORATORY INC
Active
Parent organization
BEVERLY ORTHOPEDIC LABORATORY INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEVERLY ORTHOPEDIC LABORATORY INC
Authorized official
SANJAY SURESH KAWANKAR (CEO / CFO PRACTICE MANAGER)
(323) 727-2887
Entity
Organization
Contact information
Practice address
801 N. TUSTIN AVE, #203, SANTA ANA, CA 92705
(657) 247-4301
(657) 247-4320
Mailing address
2625 W. BEVERLY BLVD, MONTEBELLO, CA 90640
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XC0008150
—
CA
Enumeration date
02/18/2021
Last updated
02/18/2021
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