RUSSELL A. GROOTEGOED DPM NPI 1720261118

NPI Information

  • NPI: 1720261118
  • Provider Name: RUSSELL A. GROOTEGOED DPM
  • Classification: Prosthetic/Orthotic Supplier - 335E00000X
  • Entity Type: Organization
  • Address: 601 W 9TH ST
    SAN PEDRO, CA
    ZIP 90731
  • Phone: (310) 833-3583

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NPI Details

RUSSELL A. GROOTEGOED DPM is a prosthetic orthotic supplier in San Pedro, CA. The provider is 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. RUSSELL A. GROOTEGOED DPM NPI is 1720261118. The provider is registered as an organization entity type.

The provider's business location address is:

601 W 9TH ST
SAN PEDRO, CA
ZIP 90731-107
Phone: (310) 833-3583

The provider's authorized official is Russell A. Grootegoed .
The authorized official title is Podiatrist and has the following contact phone number (310) 833-3583.

The enumeration date for this NPI number is 12/9/2007 and was last updated on 4/20/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1335E00000XProsthetic/Orthotic SupplierE2064CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1E2064MEDICARE PINCALIFORNIA
2=========OTHERCALIFORNIABLUE CROSS
3T11163MEDICARE UPINCALIFORNIA
43899650001MEDICARE NSCCALIFORNIA
5000E2064000MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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