Provider Demographics
NPI:1053964254
Name:PREFERRED PROSTHETICS INC
Entity type:Organization
Organization Name:PREFERRED PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-625-8450
Mailing Address - Street 1:3215 N CALIFORNIA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3433
Mailing Address - Country:US
Mailing Address - Phone:209-932-9746
Mailing Address - Fax:209-932-9765
Practice Address - Street 1:1740 MARCO POLO WAY STE 10
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4500
Practice Address - Country:US
Practice Address - Phone:650-686-6985
Practice Address - Fax:866-355-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier