Provider Demographics
NPI:1346242849
Name:LA FUENTE DME, INC.
Entity Type:Organization
Organization Name:LA FUENTE DME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:ARTURO
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-485-2400
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78595-0280
Mailing Address - Country:US
Mailing Address - Phone:956-485-1200
Mailing Address - Fax:956-485-1201
Practice Address - Street 1:307 E EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:SULLIVAN CITY
Practice Address - State:TX
Practice Address - Zip Code:78595
Practice Address - Country:US
Practice Address - Phone:956-485-1200
Practice Address - Fax:956-485-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172765301Medicaid
TX172765301Medicaid