Organization
DYNAMICS ORTHOTICS & PROSTHETICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER SEAN C.P.O. (CHIEF EXECUTIVE OFFICER)
(213) 383-9212
Entity
Organization
Contact information
Practice address
1830 W OLYMPIC BLVD, SUITE #123, LOS ANGELES, CA 90006-3734
(213) 383-9212
Mailing address
1830 W OLYMPIC BLVD, SUITE #123, LOS ANGELES, CA 90006-3734
(213) 383-9212
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
GXC000070
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005538396
AETNA
CA
05
—
GXC000070
—
CA
01
—
ZZZ54748Z
BLUE SHIELD OF CA
CA
Enumeration date
01/30/2007
Last updated
02/13/2008
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