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General NPI Number Information
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NPI Number | 1407286297
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Entity Type | Organization
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Legal Business Name | SUPERIOR PROSTHETICS & ORTHOTICS LLC
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 7400 LOUIS PASTEUR DR STE 202
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4514
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Country | US
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Telephone | 210-593-0953
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Fax | 210-593-0954
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Provider Business Mailing Address
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Address Line | 7400 LOUIS PASTEUR DR STE 202
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4514
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Country | US
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Telephone | 210-593-0953
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Fax | 210-593-0954
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Authorized Official
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Title or Position | LICENSED PROSTHETIST
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Name | MR. BACILIO V MORENO SR.
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Credential |
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Telephone | 210-593-0953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 428
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License Number State | TX
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