MEDICARE: PROSTHETICS LABORATORIES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	POR100	FL

General Provider Information

NPI Number	:	1174688246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETICS LABORATORIES INC.

Provider Business Mailing Address
First Line	:	2236 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3509
Country	:	US
Telephone Number	:	305-250-9900
Fax Number	:	305-250-9904

Provider Business Practice Location Address
First Line	:	2236 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3509
Country	:	US
Telephone Number	:	305-250-9900
Fax Number	:	305-250-9904

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PEDRO LUIS LLANES
Credential	:	L.P.O.
Telephone Number	:	305-250-9900

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/22/2020

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