Individual
MR. JACK MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
3160 GENEVA ST, LOS ANGELES, CA 90020-1117
(213) 368-3374
Mailing address
3160 GENEVA ST, LOS ANGELES, CA 90020-1117
(213) 368-3374
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO01066
DE
224P00000X
Prosthetist
Primary
CPO01066
DE
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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