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General NPI Number Information
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NPI Number | 1154011294
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS ORTHOPEDIC SHOES LLC
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 1125 JAMES ST STE G
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City | WESLACO
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State | TX
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Zip | 78596-6657
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Country | US
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Telephone | 956-998-1178
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Fax | 956-446-8182
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Provider Business Mailing Address
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Address Line | 605 J HERNANDEZ ST
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City | PROGRESO LAKES
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State | TX
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Zip | 78596-2095
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Country | US
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Telephone | 956-998-1178
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Fax | 956-446-8182
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Authorized Official
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Title or Position | CEO
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Name | ILIANA LUNA MARQUEZ
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Credential |
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Telephone | 956-998-1178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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