Provider Demographics
NPI:1104187855
Name:LOWER EXTREMITY INTERNATIONAL LLC
Entity Type:Organization
Organization Name:LOWER EXTREMITY INTERNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSUELO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-304-5829
Mailing Address - Street 1:9428 LEXINGTON AVE NE APT E
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1375
Mailing Address - Country:US
Mailing Address - Phone:505-304-5829
Mailing Address - Fax:505-212-0384
Practice Address - Street 1:9428 LEXINGTON AVE NE SUITE E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1375
Practice Address - Country:US
Practice Address - Phone:505-304-5829
Practice Address - Fax:505-212-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier