Organization
INNOVATIVE PROSTHETIC SOLUTIONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON TYRA RIKIMARU CPO (PRESIDENT)
(949) 699-0600
Entity
Organization
Contact information
Practice address
2 S POINTE DR STE 240, LAKE FOREST, CA 92630-2281
(949) 699-0600
Mailing address
2 S POINTE DR STE 240, LAKE FOREST, CA 92630-2281
(949) 699-0600
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XC0010901
—
CA
01
—
ZZZ65372Z
BLUE SHIELD OF CA
CA
Enumeration date
12/09/2005
Last updated
09/10/2025
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