Provider Demographics
NPI:1235303025
Name:PRO-TECH LABORATORY INC
Entity Type:Organization
Organization Name:PRO-TECH LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:787-279-9358
Mailing Address - Street 1:URBANIZACION VILLAS DE BUENA VISTA
Mailing Address - Street 2:F1 CALLE CRONOS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-279-9358
Mailing Address - Fax:787-279-4592
Practice Address - Street 1:CARRETERA 829 AA 4
Practice Address - Street 2:VANS COY
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-279-9358
Practice Address - Fax:787-279-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4964350001Medicare NSC