Provider Demographics
NPI:1407163546
Name:LA FE PROSTHETIC AND MEDICAL DEVICES, LLC
Entity Type:Organization
Organization Name:LA FE PROSTHETIC AND MEDICAL DEVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:AR
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-259-5233
Mailing Address - Street 1:108 CALLE VICTORIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3767
Mailing Address - Country:US
Mailing Address - Phone:787-259-5233
Mailing Address - Fax:787-848-0858
Practice Address - Street 1:108 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3767
Practice Address - Country:US
Practice Address - Phone:787-259-5233
Practice Address - Fax:787-848-0858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier