Individual
ALPHA ISCANDARI SANUSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BOCPO
Contact information
Practice address
1760 CHICAGO AVE STE L21, RIVERSIDE, CA 92507-2326
(626) 622-3359
Mailing address
1760 CHICAGO AVE STE L21, RIVERSIDE, CA 92507-2326
(626) 622-3359
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
C51502
CA
224P00000X
Prosthetist
Primary
C51502
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C51502
ORTHOTIST/PROSTHETIST CREDENTIAL
CA
Enumeration date
08/22/2019
Last updated
08/22/2019
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