Organization
L.I.C PROSTHETICS AND ORTHOTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERICK FARROKH RANDJBAR BOCPO (OWNER/DIRECTOR)
(714) 563-0056
Entity
Organization
Contact information
Practice address
321 E CENTER ST, ANAHEIM, CA 92805-3263
(714) 563-0056
Mailing address
321 E CENTER ST, ANAHEIM, CA 92805-3263
(714) 563-0056
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
C21643
MD
Other
Enumeration date
11/04/2005
Last updated
06/01/2011
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