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Russell A. Grootegoed Dpm
Prosthetic/Orthotic Supplier in San Pedro, California
NPI 1720261118

Russell A. Grootegoed Dpm is a Prosthetic/Orthotic Supplier based in San Pedro, CA. Russell A. Grootegoed Dpm practices in San Pedro, CA. The NPI Number for Russell A. Grootegoed Dpm is 1720261118 and holds a License No. E2064 (California).

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

Location: 601 W 9Th St, San Pedro, CA, 90731-3107
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1720261118
Provider Name
Russell A. Grootegoed Dpm
Credential
Provider Entity Type
Organization
Address
601 W 9Th St, San Pedro, CA, 90731-3107
Phone Number
310-833-3583
Fax Number
Provider Enumeration Date
12/09/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
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
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
person
Provider's Taxonomy Details 1
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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