Provider Demographics
NPI:1174688246
Name:PROSTHETICS LABORATORIES INC.
Entity Type:Organization
Organization Name:PROSTHETICS LABORATORIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:305-250-9900
Mailing Address - Street 1:2236 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3509
Mailing Address - Country:US
Mailing Address - Phone:305-250-9900
Mailing Address - Fax:305-250-9904
Practice Address - Street 1:2236 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3509
Practice Address - Country:US
Practice Address - Phone:305-250-9900
Practice Address - Fax:305-250-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR100335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0506170001Medicare ID - Type Unspecified