Healthcare Provider Details

I. General information

NPI: 1407163546
Provider Name (Legal Business Name): LA FE PROSTHETIC AND MEDICAL DEVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CALLE VICTORIA
PONCE PR
00730-3767
US

IV. Provider business mailing address

108 CALLE VICTORIA
PONCE PR
00730-3767
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-5233
  • Fax: 787-848-0858
Mailing address:
  • Phone: 787-259-5233
  • Fax: 787-848-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS A.R. QUESADA
Title or Position: CHIEF EXECUTIVE MANAGER
Credential:
Phone: 787-259-5233