Provider Demographics
NPI:1205019965
Name:MEDICAL PROSTHETIC
Entity Type:Organization
Organization Name:MEDICAL PROSTHETIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PONTON
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:787-359-4770
Mailing Address - Street 1:EBANO 74 MONTECASINO
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-359-4770
Mailing Address - Fax:787-359-4770
Practice Address - Street 1:EBANO 74 MONTECASINO
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-359-4770
Practice Address - Fax:787-359-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee