Organization · NPI-2

Beverly Orthopedic Laboratory INC.

Prosthetic/Orthotic Supplier · Riverside, CA

NPI number1487359832

StatusActive

Last updated in NPPESApr 4, 2023

Details

NPI: 1487359832
Entity type: Organization (NPI-2)
Legal business name: Beverly Orthopedic Laboratory INC.
Organization subpart: Yes
Enumeration date: Apr 4, 2023
Certification date: Apr 4, 2023
Last updated: Apr 4, 2023

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
335E00000X	Prosthetic/Orthotic Supplier	–	–	Yes
261QP2000X	Clinic/Center, Physical Therapy	–	–

Practice location

4150 Latham Street Suite:g
Riverside, CA 92501-0001

Phone 951-742-5127 · Fax 951-742-5184

Mailing address

2625 W Beverly Blvd
Montebello, CA 90640-0031

Phone 323-727-2887 · Fax 323-727-2854

Authorized official

Sanjay S Kawankar
Ceo/Cfo
3237272887

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