Organization
PROSTHETIC SOLUTIONS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WADE THOMAS SKARDOUTOS CP (PRESIDENT)
(408) 845-9245
Entity
Organization
Contact information
Practice address
3350 SCOTT BLVD, SUITE 6301, SANTA CLARA, CA 95054-3109
(408) 845-9245
(408) 845-9259
Mailing address
3350 SCOTT BLVD, SUITE 6301, SANTA CLARA, CA 95054-3109
(408) 845-9245
(408) 845-9259
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CP003200
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610058700
U.S. DEPT OF LABOR
CA
01
—
ZZZ66207Z
BLUE SHIELD PIN
CA
01
—
ZZZ66208Z
BLUE SHIELD PIN
CA
Enumeration date
10/02/2006
Last updated
09/26/2016
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