Organization
CORE PROSTHETICS LAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TUTY IRIANTO CFM01267 (MANAGER)
(951) 246-8888
Entity
Organization
Contact information
Practice address
29723 NEW HUB DR STE A, SUN CITY, CA 92586-6537
(951) 246-8888
(951) 246-8675
Mailing address
29723 NEW HUB DR STE A, SUN CITY, CA 92586-6537
(951) 246-8888
(951) 246-8675
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
CFM01267
DE
335E00000X
Prosthetic/Orthotic Supplier
Primary
P1115
DE
Other
Enumeration date
04/24/2008
Last updated
11/19/2009
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