Peninsula Prosthetics, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

PENINSULA PROSTHETICS, INC.

Practice address

165 Valley Dr
Brisbane, CA 94005-1340

Phone

(916) 412-7813

Fax

(866) 355-5906

NPI assigned

Sep 6, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jonathan Michael Smith, CPONPI 1023207875

Title

President

Phone

(916) 412-7813

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan Smith, CO

  • Orthotist
  • Sacramento, CA
  • NPI 1023207875
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1043096811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 HAMILTON CT",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940441543",
            "telephone_number": "916-412-7813",
            "fax_number": "866-355-5906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 VALLEY DR",
            "city": "BRISBANE",
            "state": "CA",
            "postal_code": "940051340",
            "telephone_number": "916-412-7813",
            "fax_number": "866-355-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PROSTHETICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-06",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "916-412-7813",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Martin Fadrhonc
• Christiane Alves Miranda
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• Thao Nguyen, FNP
• Sadna G Patel
• Pillpack LLC
• Sarah Proehl, M.D.
• Cecilia Ramirez
• Emilio Recacha
• Charles P. Semba, M.D.

• Prosthetic/Orthotic Supplier in Brisbane, CA
• Providers in Brisbane, CA by specialty
• Prosthetic/Orthotic Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.