Organization
TEMECULA VALLEY ORTHOITCS & PROSTHETICS, INC.
Active
Other names
Temecula Valley O&P
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN J MATHENY CO (PRESIDENT)
(951) 696-4447
Entity
Organization
Contact information
Practice address
36243 INLAND VALLEY DR STE 30, WILDOMAR, CA 92595-9547
(951) 696-4447
(951) 696-4448
Mailing address
36243 INLAND VALLEY DR STE 30, WILDOMAR, CA 92595-9547
(951) 696-4447
(951) 696-4448
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CPO19140
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4898339
BLUE CROSS PROVIDER NUMBE
CA
01
—
5573
HEALTH NET PROVIDER NUMBE
CA
05
—
CMS170123
—
CA
05
—
XC0019140
—
CA
01
—
ZZZ03626Z
BLUE SHIELD PROVIDER NUMB
CA
Enumeration date
07/11/2006
Last updated
08/22/2020
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