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General NPI Number Information
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NPI Number | 1467465690
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO PROSTHETICS, CORPORATION
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 2147 EL INDIO HWY
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City | EAGLE PASS
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State | TX
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Zip | 78852-5455
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Country | US
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Telephone | 830-757-5183
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Fax | 830-773-3298
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Provider Business Mailing Address
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Address Line | 11933 NETWORK BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78249-3399
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Country | US
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Telephone | 210-616-0761
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Fax | 210-616-0157
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Authorized Official
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Title or Position | ORTHOTIST PROSTHETIST OWNER PRES
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Name | MR. LORENZO LECHUGA GONZALEZ
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Credential | CPO BOC LPO
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Telephone | 210-616-0761
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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 | LOP 101
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License Number State | TX
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