Organization
BEVERLY ORTHOPEDIC LABORATORY INC
Active
Parent organization
BEVERLY ORTHOPEDIC LABORATORY INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEVERLY ORTHOPEDIC LABORATORY INC
Authorized official
SANJAY SURESH KAWANKAR CP, BOCPO (CEO, CFO, PRACTICE MANAGER)
(323) 727-2887
Entity
Organization
Contact information
Practice address
3000 W OLYMPIC BLVD, #301, LOS ANGELES, CA 90006
(213) 351-3556
(213) 351-3558
Mailing address
3625 W BEVERLY BLVD, MONTEBELLO, CA 90640
(323) 727-2887
(323) 727-2854
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XC000815
—
CA
Enumeration date
03/19/2021
Last updated
03/19/2021
Update your record
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