Organization
CUSTOM ORTHOPEDIC APPLIANCES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER KONIUK CO (OWNER/CERTIFIED ORTHOTIST)
(415) 552-1330
Entity
Organization
Contact information
Practice address
340 DIVISADERO ST, SAN FRANCISCO, CA 94117-2209
(415) 552-1330
(415) 861-2955
Mailing address
340 DIVISADERO ST, SAN FRANCISCO, CA 94117-2209
(415) 552-1330
(415) 861-2955
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GFA000060
—
CA
Enumeration date
11/01/2006
Last updated
08/22/2020
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