MEDICARE: PROSTHETIC INNOVATIONS 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

General Provider Information

NPI Number	:	1417430257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETIC INNOVATIONS INC

Provider Business Mailing Address
First Line	:	5309 WURZBACH RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-2431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5309 WURZBACH RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-2431
Country	:	US
Telephone Number	:	210-290-9225
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EVERARDO CERVANTES
Credential	:
Telephone Number	:	956-763-3661

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	02/16/2026

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Directions to “PROSTHETIC INNOVATIONS INC ” Practice Location

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