Organization
BEVERLY ORTHOPEDIC LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANJAY S KAWANKAR CP, BOCPO (CEO/CFO)
(323) 727-2887
Entity
Organization
Contact information
Practice address
2625 W BEVERLY BLVD, MONTEBELLO, CA 90640
(323) 727-2887
(323) 727-2854
Mailing address
2625 W BEVERLY BLVD, MONTEBELLO, CA 90640
(323) 727-2887
(323) 727-2854
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
—
XCOOO8150
—
CA
01
—
ZZZ02896Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
08/05/2006
Last updated
05/22/2020
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