Core Prosthetics Lab, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

P1115 Issued in DE

Legal business name

CORE PROSTHETICS LAB, INC.

Practice address

29723 New Hub Dr Ste a
Sun City, CA 92586-6537

Phone

(951) 246-8888

Fax

(951) 246-8675

NPI assigned

Apr 24, 2008

Last updated

Nov 19, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tuty Irianto, CFM01267

Title

Manager

Phone

(951) 246-8888

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258588800000",
    "number": "1720253305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29723 NEW HUB DR STE A",
            "city": "SUN CITY",
            "state": "CA",
            "postal_code": "925866537",
            "telephone_number": "951-246-8888",
            "fax_number": "951-246-8675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29723 NEW HUB DR STE A",
            "city": "SUN CITY",
            "state": "CA",
            "postal_code": "925866537",
            "telephone_number": "951-246-8888",
            "fax_number": "951-246-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE PROSTHETICS LAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2009-11-19",
        "status": "A",
        "authorized_official_last_name": "IRIANTO",
        "authorized_official_first_name": "TUTY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "951-246-8888",
        "authorized_official_credential": "CFM01267"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "DE",
            "license": "CFM01267",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "DE",
            "license": "P1115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Sun City, CA
• Providers in Sun City, 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 Nov 19, 2009; 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.