=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679519243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMPA BAY ARTIFICIAL LIMBS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2006
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5109 N ARMENIA AVE
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33603-1405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-801-9110
-----------------------------------------------------
Fax | 813-801-9048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5109 N ARMENIA AVE
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33603-1405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-801-9110
-----------------------------------------------------
Fax | 813-801-9048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARIA PAULA GOMEZ
-----------------------------------------------------
Credential | CPO
-----------------------------------------------------
Telephone | 813-801-9110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | PRO 25
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------