Organization
ACTIVE 1 PROSTHETICS AND ORTHOTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHAN MARK MAGILL C.P.O. (PRESIDENT)
(559) 493-5020
Entity
Organization
Contact information
Practice address
295 W CROMWELL AVE, SUITE 102, FRESNO, CA 93711-6167
(559) 493-5020
(559) 492-3569
Mailing address
295 W CROMWELL AVE, SUITE 102, FRESNO, CA 93711-6167
(559) 493-5020
(559) 492-3569
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
04/17/2015
Last updated
04/17/2015
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