Provider Demographics
NPI:1447594700
Name:PETER HARSCH PROSTHETICS, LLC
Entity type:Organization
Organization Name:PETER HARSCH PROSTHETICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP OF LICENSURE & ACCREDITATION
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-777-0825
Mailing Address - Street 1:5995 MIRA MESA BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4305
Mailing Address - Country:US
Mailing Address - Phone:858-404-0733
Mailing Address - Fax:858-404-0745
Practice Address - Street 1:5995 MIRA MESA BLVD
Practice Address - Street 2:STE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4305
Practice Address - Country:US
Practice Address - Phone:858-404-0733
Practice Address - Fax:858-404-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2749224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty