Provider Demographics
NPI:1467465690
Name:SAN ANTONIO PROSTHETICS, CORPORATION
Entity Type:Organization
Organization Name:SAN ANTONIO PROSTHETICS, CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST PROSTHETIST OWNER PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:LECHUGA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPO BOC LPO
Authorized Official - Phone:210-616-0761
Mailing Address - Street 1:11933 NETWORK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3399
Mailing Address - Country:US
Mailing Address - Phone:210-616-0761
Mailing Address - Fax:210-616-0157
Practice Address - Street 1:2147 EL INDIO HWY
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5455
Practice Address - Country:US
Practice Address - Phone:830-757-5183
Practice Address - Fax:830-773-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLOP 101335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212771401Medicaid
TX212771401Medicaid