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General NPI Number Information
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NPI Number | 1023528015
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Entity Type | Organization
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Legal Business Name | PROSTHETIC TECHNOLOGY CENTER, INC
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 7254 BLANCO RD STE 200
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City | SAN ANTONIO
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State | TX
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Zip | 78216-4930
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Country | US
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Telephone | 210-600-9884
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Fax | 210-600-9883
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Provider Business Mailing Address
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Address Line | 9069 W 33RD AVE
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City | HIALEAH
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State | FL
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Zip | 33018-1883
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Country | US
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Telephone | 562-373-8667
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Fax | 844-828-8593
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Authorized Official
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Title or Position | PROSTHETIST/PRESIDENT
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Name | JOHN LIBER MOSQUERA CASTRO
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Credential | CP/LP
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Telephone | 562-373-8667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | 1774
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License Number State | TX
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