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Russell A. Grootegoed, DPM
Prosthetic/Orthotic Supplier in San Pedro, California
NPI 1194767921

Russell A. Grootegoed is a Prosthetic/Orthotic Supplier based in San Pedro, CA. Russell A. Grootegoed practices in San Pedro, CA and has the professional credentials of DPM. The NPI Number for Russell A. Grootegoed is 1194767921 and holds a License No. E2064 (California).

The current practice location address for Russell A. Grootegoed is 601 W 9Th St, San Pedro, CA and can be reached out via phone at 310-833-3583 and via fax at 310-833-1976.

Location: 601 W 9Th St, San Pedro, CA, 90731-3107
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1194767921
Provider Name
Russell A. Grootegoed
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
601 W 9Th St, San Pedro, CA, 90731-3107
Phone Number
310-833-3583
Fax Number
310-833-1976
Provider Enumeration Date
06/13/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
953239247 01 CA BLUE CROSS
000E2064000 05 CA
institution
Provider Business Practice Location Address Details
Address
601 W 9Th St
City
San Pedro
State
California
Zip
90731-3107
Phone Number
310-833-3583
Fax Number
310-833-1976
person
Provider Business Mailing Address Details
Address
601 W 9Th St
City
San Pedro
State
California
Zip
90731-3107
Phone Number
310-833-3583
Fax Number
310-833-1976
person
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot & Ankle Surgery
Taxonomy
213ES0103X
License No.
E2064 (California)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Suppliers
Classification
Prosthetic/Orthotic Supplier
Speciality
-
Taxonomy
335E00000X
License No.
E2064 (California)
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
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